Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study

OBJECTIVE: To evaluate the effects of sensory-amplitude electric stimulation (SES) of the paretic leg on motor recovery and gait kinematics of patients with stroke. DESIGN: Randomized, controlled, double-blind study. SETTING: Rehabilitation ward and gait laboratory of a university hospital. PARTICIPANTS: A total of 30 consecutive inpatients with stroke (mean age, 63.2 y), all within 6 months poststroke and without volitional ankle dorsiflexion were studied. INTERVENTION: Both the SES group (n=15) and the placebo group (n=15) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks. The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks. MAIN OUTCOME MEASURES: Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait. RESULTS: Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the SES group and 56% of the placebo group gained voluntary ankle dorsiflexion. The between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the between-group difference was not significant. CONCLUSIONS: In our patients with stroke, SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics.     

Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial

OBJECTIVE: To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.5 y), all within 12 months poststroke and without volitional ankle dorsiflexion. INTERVENTIONS: Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories [FAC]), and motor functioning (motor items of the FIM instrument). RESULTS: The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 0.8; 95% CI, 0.5-1.2; P=.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2-24.7; vs mean, 12.5; 95% CI, 9.6-14.8; P=.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4-1.2; vs mean, 0.3; 95% CI, 0.1-0.7; P=.102) nor FAC (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 1.5; 95% CI, 1.1-1.9; P=.610) showed a significant difference between the groups. CONCLUSIONS: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.     

Somatosensory impairment after stroke: frequency of different deficits and their recovery

OBJECTIVE: To investigate the frequency of somatosensory impairment in stroke patients within different somatosensory modalities and different body areas, and their recovery. DESIGN: Prospective observational study. SETTING: Two stroke rehabilitation units. SUBJECTS: Seventy patients with a first stroke (36 men, 34 women; average age, 71, SD 10.00 years; average time since stroke onset, 15 days) were assessed on admission and two, four and six months after stroke. INTERVENTIONS: Not applicable. MAIN MEASURE: Nottingham Sensory Assessment. RESULTS: Somatosensory impairment was common after stroke; 7-53% had impaired tactile sensations, 31-89% impaired stereognosis, and 34-64% impaired proprioception. When comparing somatosensory modalities within body areas the kappa values were low (kappa values<0.54). Recovery occurred over time, though not significantly in lower limb tactile sensations. Stroke severity was the main factor influencing initial somatosensory impairment, but accounted for a small amount of the variance (21-41%). Initial somatosensory impairment was significantly related to somatosensory ability at six months, accounting for 46-71% of the variance. CONCLUSIONS: Proprioception and stereognosis were more frequently impaired than tactile sensations. The different somatosensory modalities showed only slight agreement between impairment within the same body areas, suggesting that the modalities are independent of each other and all should be assessed. High agreements were found between different body areas for each somatosensory modality. Somatosensory impairment was associated with stroke severity, however low variance indicated other factors were involved.     

Bobath球训练对脑卒中偏瘫患者运动功能的影响

目的 探讨Bobath球训练对脑卒中偏瘫患者运动功能的影响。方法 将40例脑卒中偏瘫患者随机分为A、B两组,每组20例,两组均予常规康复治疗。A组在常规治疗基础上增加Bobath球训练,每次20分钟,每周治疗6次,治疗4周。2组均于治疗前及治疗4周后采用Fugl-Meyer运动功能评定量表(FMA)、Berg平衡量表(BBS)和改良Bethel指数评定表(BI)分别评定运动功能、平衡能力及日常生活能力。结果 治疗前,两组FMA、BBS及BI评分比较差异均无统计学意义(P>0.05)。经过4周治疗后, 两组各项疗效指标均较治疗前有明显改善 (P<0.05), 且A组的改善程度显著优于B组, 两组比较差异具有统计学意义(P<0.05)。结论 Bobath球训练能更好改善脑卒中偏瘫患者的运动功能、平衡及日常生活能力。     

Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial

OBJECTIVE: To study the effects of augmented exercise therapy time for arm rehabilitation as either Bobath therapy or the impairment-oriented training (Arm BASIS training) in stroke patients with arm severe paresis. DESIGN: Single blind, multicentre randomized control trial. SETTING: Three inpatient neurorehabilitation centres. SUBJECTS: Sixty-two anterior circulation ischaemic stroke patients. INTERVENTIONS: Random assignment to three group: (A) no augmented exercise therapy time, (B) augmented exercise therapy time as Bobath therapy and (C) augmented exercise therapy time as Arm BASIS training. MAIN MEASURES: Main outcome measure: Fugl-Meyer arm motor score. Secondary measure: Action Research Arm Test (ARA). Ancillary measures: Fugl-Meyer arm sensation and joint motion/pain scores and the Ashworth Scale (elbow flexors). RESULTS: An overall effect of augmented exercise therapy time on Fugl-Meyer scores after four weeks was not corroborated (mean and 95% confidence interval (CI) of change scores: no augmented exercise therapy time (n=20) 8.8, 5.2-12.3; augmented exercise therapy time (n=40) 9.9, 6.8-13.9; p = 0.2657). The group who received the augmented exercise therapy time as Arm BASIS training (n=20) had, however, higher gains than the group receiving the augmented exercise therapy time as Bobath therapy (n=20) (mean and 95% CI of change scores: Bobath 7.2, 2.6-11.8; BASIS 12.6, 8.4-16.8; p = 0.0432). Passive joint motion/pain deteriorated less in the group who received BASIS training (mean and 95% CI of change scores: Bobath -3.2, -5.2 to -1.1; BASIS 0.1, -1.8-2.0; p = 0.0090). ARA, Fugl-Meyer arm sensation, and Ashworth Scale scores were not differentially affected. CONCLUSIONS: The augmented exercise therapy time as Arm BASIS training enhanced selective motor control. Type of training was more relevant for recovery of motor control than therapeutic time spent.     

Effects of acupuncture treatment on motor function in patients with subacute hemorrhagic stroke: A randomized controlled study

ObjectiveThe aim of this study was to evaluate the additional effects of acupuncture treatment on motor function in patients with subacute hemorrhagic stroke.DesignOne hundred and thirty-four patients with subacute hemorrhagic stroke were randomized to receive acupuncture treatment plus conventional treatment (treatment group) or conventional treatment only (control group). Acupuncture treatments were given in 24 sessions over 4 weeks, with 3-month follow-up period. Blinded evaluation was based on Fugl-Meyer Assessment, Barthel Index with an intention-to-treat analysis. For those patients who were able to walk, a three-dimensional gait analysis system was employed to objectively record spatiotemporal and kinematic parameters.ResultsCompared with control group, the treatment group showed a significantly greater over-time improvement in total Fugl-Meyer, lower-limb Fugl-Meyer, but not in upper-limb Fugl-Meyer and Barthel Index. The spatiotemporal parameters of velocity, step length, cadence, step width all showed significant difference between the 2 groups. The velocity in treatment group decreased unexpectedly at day 14, then increased sharply and overcame control group at day 28. The treatment group also showed a significantly greater increase in peak circumduction, peak hip hiking, hip range of motion, knee range of motion and a tendency for the ankle range of motion.ConclusionsAcupuncture may promote the motor function recovery of hemorrhagic stroke patients in subacute phase mainly by enhancing the lower limb ability. It probably diminishes the compensation strategies earlier to correct the abnormal gait pattern. Although this adjustment may result in a compromise in the improvement of gait velocity temporarily, patients would benefit from it in a long run.     

Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial

OBJECTIVE: To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone. DESIGN: Randomized controlled trial. SETTING: Rehabilitation unit. SUBJECTS: Fifty patients, first-time supratentorial stroke, stroke interval less than six weeks, Barthel Index (0-100) from 50 to 80, able to walk a minimum distance of 12 m with either intermittent help or stand-by while walking, cardiovascular stable, minimum 50 W in the bicycle ergometry, randomly allocated to two groups, A and B. INTERVENTIONS: Group A 30 min of treadmill training, harness secured and minimally supported according to patients' needs, and 30 min of physiotherapy, every workday for six weeks, speed and inclination of the treadmill were adjusted to achieve a heart rate of HR: (Hrmax-HRrest)*0.6+HRrest; in group B 60 min of daily physiotherapy for six weeks. MAIN OUTCOME MEASURES: Primary outcome variables were the absolute improvement of walking velocity (m/s) and capacity (m), secondary were gross motor function including walking ability (score out of 13) and walking quality (score out of 41), blindly assessed before and after the intervention, and at follow-up three months later. RESULTS: Patients tolerated the aerobic training well with no side-effects, significantly greater improvement of walking velocity and capacity both at study end (p =0.001 versus p =0.002) and at follow-up (p <0.001 versus p <0.001) in the experimental group. Between weeks 0 and 6, the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m, the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18, the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m, the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time. CONCLUSIONS: Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity. The treatment approach is recommended in patients meeting the inclusion criteria. A multicentre trial should follow to strengthen the evidence.     

康复干预脑卒中抑郁患者不同阶段的神经功能恢复测评

目的:探讨脑卒中后抑郁(post-strokedepression,PSD)对神经功能康复不同阶段的影响。方法:应用汉密尔顿抑郁量表(HAMD)、神经功能缺损评分标准(NFA)、运动功能测定(FMA)和日常生活活动能力测定(BI),对124例脑卒中患者的临床治疗和康复训练效果进行测评分析。结果:脑卒中伴有中重度PSD患者在临床治疗、心理干预和康复训练3个月及6个月后,HAMD,NFA,FMA,和BI各项测评指标分别为20.78～14.23分,16.80～13.82分,34.63～38.40分,38.56～38.25分,各项指标均显著低于非抑郁患者和轻度抑郁患者(t=2.002～10.336,P<0.05,0.01)。结论:脑卒中患者伴有PSD,对神经功能康复不同阶段均有较大不利影响。     

Neuromuscular electric stimulation effect on lower-extremity motor recovery and gait kinematics of patients with stroke: a randomized controlled trial

OBJECTIVE: To evaluate the effects of neuromuscular electric stimulation (NMES) of the tibialis anterior muscle on motor recovery and gait kinematics of patients with stroke. DESIGN: Randomized, controlled, assessor-blinded trial. SETTING: Rehabilitation ward and gait laboratory of a university hospital. PARTICIPANTS: A total of 25 consecutive inpatients with stroke (mean age, 55y), all within 6 months poststroke and without volitional ankle dorsiflexion. INTERVENTION: Both the NMES group (n=12) and the control group (n=13) participated in a conventional stroke rehabilitation program, 5 days a week for 4 weeks. The NMES group also received 10 minutes of NMES to the tibialis anterior muscle of the paretic limb. MAIN OUTCOME MEASURES: Brunnstrom stages of motor recovery and kinematic characteristics of gait. RESULTS: Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the NMES group and 61% of the control group gained voluntary ankle dorsiflexion. Between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the difference between groups was not significant. CONCLUSIONS: NMES of the tibialis anterior muscle combined with a conventional stroke rehabilitation program was not superior to a conventional stroke rehabilitation program alone, in terms of lower-extremity motor recovery and gait kinematics.     

下肢康复机器人联合等速肌力训练对脑卒中后下肢运动功能影响的临床对照研究

目的:观察下肢康复机器人联合等速肌力训练对脑卒中后下肢运动功能的影响。方法:将脑卒中患者75例随机分为3组,每组25例。3组病人均进行常规康复,A组增加下肢康复机器人训练,B组增加下肢等速肌力训练,C组增加下肢康复机器人联合等速肌力训练。每周训练6次,共治疗6周。治疗前后进行等速肌力测试(峰力矩值)、下肢Fugl-Meyer运动功能评分(FMA)、Berg平衡量表(BBS)及Holden步行功能分级评定。结果:治疗6周后组内比较,3组患者的峰力矩值、FMA评分、BBS评分及Holden步行功能分级较治疗前提高,差异具有统计学意义(P<0.05)。组间比较,治疗6周后组间比较,C组在角速度60°/s、120°/s及180°/s下的伸膝肌及屈膝肌峰力矩值、BBS评分均高于A组和B组,差异具有统计学意义(P<0.05),但A组与B组比较差异无统计学意义。结论:下肢康复机器人联合等速肌力训练在改善脑卒中患者下肢肌力、平衡功能和步行能力方面较两者单独应用疗效更佳。     

经颅和外周磁刺激治疗脑卒中后上肢运动功能障碍的随机对照研究

目的:观察对比外周磁刺激(peripheral magnetic stimulation,PMS)和中枢磁刺激对脑卒中后中重度上肢运动功能障碍的影响.方法:共42例符合纳入标准的脑卒中患者参加试验,将所有受试者随机分为对照组(14例)、PMS组(13例)和中枢组(15例).对照组接受常规康复治疗,PMS组在常规康复治疗...     

Effects of robotic therapy on motor impairment and recovery in chronic stroke

OBJECTIVE: To examine whether robotic therapy can reduce motor impairment and enhance recovery of the hemiparetic arm in persons with chronic stroke. DESIGN: Pre-posttest design. SETTING: Rehabilitation hospital, outpatient care. PARTICIPANTS: Volunteer sample of 20 persons diagnosed with a single, unilateral stroke within the past 1 to 5 years, with persistent hemiparesis. INTERVENTIONS: Robotic therapy was provided 3 times weekly for 6 weeks. Subjects able to reach robot targets were randomly assigned to sensorimotor or progressive-resistive robotic therapy groups. Robotic therapy consisted of goal-directed, planar reaching tasks to exercise the hemiparetic shoulder and elbow. MAIN OUTCOME MEASURES: The Modified Ashworth Scale, Fugl-Meyer test of upper-extremity function, Motor Status Scale (MSS) score, and Medical Research Council motor power score. RESULTS: Evaluations by a single blinded therapist revealed statistically significant gains from admission to discharge (P<.05) on the Fugl-Meyer test, MSS score, and motor power score. Secondary analyses revealed group differences: the progressive-resistive therapy group experienced nonspecific improvements on wrist and hand MSS scores that were not observed in the sensorimotor group. CONCLUSIONS: Robotic therapy may complement other treatment approaches by reducing motor impairment in persons with moderate to severe chronic impairments.     

运动观察疗法对恢复后期脑卒中患者手功能障碍的疗效研究

目的:探讨运动观察疗法(AOT)和重复经颅磁刺激(rTMS)分别结合作业治疗对恢复后期脑卒中患者手功能恢复的临床疗效差异.方法:将52例住院脑卒中患者随机分为对照组16例、AOT组19例和rTMS组17例.对照组接受常规的作业治疗,运动观察疗法组在此基础上增加AOT治疗,rTMS组在此基础上增加rTMS治疗,在治疗前及...     

Time-course of changes in arm impairment after stroke: variables predicting motor recovery over 12 months

Mirbagheri MM, Rymer WZ. Time-course of changes in arm impairment after stroke: variables predicting motor recovery over 12 months.

Objectives

To characterize the time-course of changes in motor recovery in the upper extremity of hemiparetic stroke survivors over a 1-year interval after stroke, and to use kinematic and kinetic recordings of elbow voluntary movement at 1 month to predict recovery over this 1-year period.

Design

Motor impairment was assessed using the Fugl-Meyer Assessment (FMA) of the upper extremity. The angular elbow movement trajectory and its derivatives were recorded. Limb kinetics were quantified using maximum voluntary contractions. Subjects were examined at 1, 2, 3, 6, and 12 months after stroke. The growth mixture model was used to characterize the recovery patterns of the FMA over 1 year, and a logistic regression analysis was used to predict these patterns with the kinematic and kinetic measures recorded at 1 month.

Setting

A hospital-based laboratory with a movement testing system including position and torque sensors.

Participants

Hemiparetic stroke survivors (N=20) with upper-extremity impairment recruited within 4 weeks poststroke.

Interventions

Not applicable.

Main Outcome Measures

Kinematic parameters, including active range of motion, peak velocity, peak acceleration, movement smoothness, and movement speed; kinetic parameters, including isometric voluntary contraction of elbow extensors and flexors; and clinical measurement of motor impairment (FMA).

Results

We found 2 classes of recovery patterns. Class 1 subjects started with a low-level FMA score and then increased quickly before tapering off gradually. Conversely, class 2 subjects started with a high-level FMA score that remained constant or increased slightly. Using logistic regression, the impact of each kinematic and kinetic measure on class membership was characterized. The class assignment helped predict the recovery pattern of motor impairment for each subject.

Conclusions

Using elbow kinematic and kinetic measures 1 month after stroke, we were able to predict accurately the recovery of arm impairment in subjects with hemiparetic stroke at different time points in the first year. This information is of potential value for planning targeted therapeutic interventions.     

步行速度在脑卒中患者运动功能恢复评定中的价值

目的探讨步行速度在脑卒中偏瘫患者运动功能恢复评定中的价值。方法对 5 5例患者进行 10m最大步行速度(MWS)的评价、简式Fugl Meyer法下肢运动功能评价 (FMA L)、Motricity指数下肢评价 (MI L)、Berg平衡评价 (BBS)和FIM的转移和行进能力评价 (FIM A)。另选择 10例年龄相仿健康成人进行 10m最大步行速度评测作为标准对照值。按实用步行速度的要求将患者分成 3组。用Pearson相关分析最大步行速度与临床变量之间的关系。结果低速组患者的MWS与其MI L、FMA L、BBS和FIM A之间存在中度相关性 (r =0 5 81-0 770 ,P <0 0 5 ) ;而中速组和快速组的MWS与其MI L、FMA L、BBS和FIM A之间不存在相关性 (r =0 0 16-0 3 80 ,P >0 0 5 )。步行速度达到 44 8m /min(或标准值的 41 3 % )以上时 ,步行速度与平衡、肌力、运动模式和移动能力之间的关系明显被消弱。结论步行速度在脑卒中患者功能结局评定上是一个独立的变量。