Predicting recovery of dextrous hand function in acute stroke

Background. No strongly clinical evidence about the use of hand robot-assisted therapy in stroke patients was demonstrated. This preliminary observer study was aimed at evaluating the efficacy of intensive robot-assisted therapy in hand function recovery, in the early phase after a stroke onset.Methods. Seven acute ischemic stroke patients at their first-ever stroke were enrolled. Treatment was performed using Amadeo robotic system (Tyromotion GmbH Graz, Austria). Each participant received, in addition to inpatients standard rehabilitative treatment, 20 sessions of robotic treatment for 4 consecutive weeks (5 days/week). Each session lasted for 40 minutes. The exercises were carried out as follows: passive modality (5 minutes), passive/plus modality (5 minutes), assisted therapy (10 minutes), and balloon (10 minutes). The following impairment and functional evaluations, Fugl-Meyer Scale (FM), Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles) (MRC), Motricity Index (MI), and modified Ashworth Scale for wrist and hand muscles (AS), were performed at the beginning (T0), after 10 sessions (T1), and at the end of the treatment (T2). The strength hand flexion and extension performed by Robot were assessed at T0 and T2. The Barthel Index and COMP (performance and satisfaction subscale) were assessed at T0 and T2.Results. Clinical improvements were found in all patients. No dropouts were recorded during the treatment and all subjects fulfilled the protocol. Evidence of a significant improvement was demonstrated by the Friedman test for the MRC (P<0.0123). Evidence of an improvement was demonstrated for AS, FM, and MI.Conclusions. This original rehabilitation treatment could contribute to increase the hand motor recovery in acute stroke patients. The simplicity of the treatment, the lack of side effects, and the first positive results in acute stroke patients support the recommendations to extend the clinical trial of this treatment, in association with physiotherapy and/or occupational therapy.

Download Full-text

EFFICACY OF FUNCTIONAL NEUROMUSCULAR ELECTRICAL STIMULATION (FNMES) IN THE IMPROVEMENT OF HAND FUNCTIONS IN ACUTE STROKE SURVIVALS

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703606 ◽

2012 ◽

Vol 02 (04) ◽

pp. 16-21

Author(s):

Mohamed Faisal C. K. ◽

Priyabandani Neha Om Prakash ◽

Ajith S.

Keyword(s):

Electrical Stimulation ◽

Acute Stroke ◽

Hand Function ◽

Neuromuscular Electrical Stimulation ◽

Control Group ◽

Stroke Patients ◽

Hand Functions ◽

Conventional Physiotherapy ◽

Block Test ◽

Experimental Group

AbstractStroke is a worldwide health problem. Hand function is one of the important factors which are affected in stroke. Stroke patients are usually given a conventional physiotherapy but if an additional FNMES is given it might show better improvement. By keeping these facts in view, the present study aims at evaluating and comparing the efficacy of conventional physiotherapy and adding FNMES will make any better outcome in the acute stroke survivals. The subjects were randomly assigned to any of the two groups; control group consisted of 15 subjects who received only conventional therapy for 4 weeks and experimental group consisting of 15 subjects who received an additional FNMES along with conventional physiotherapy for 4 weeks. The hand function was assessed on day 1 and to know the recovery, at the end of four weeks of intervention with the help of action research arm test (ARAT) and box and block test (BBT). At the end of 4 weeks of intervention both the groups showed significant improvements. On ARAT, control group showed a mean of 10.2000 whereas, experimental group showed mean of 20.8000 with p = 0.001 (p ≤ 0.05) and on BBT, the control group showed a mean of 21.666 and experimental group showed 30.933 with p = 0.41 (p ≤ S 0.05). Therefore the study concludes that, though there was improvement in both the groups, the experimental group who received an additional FNMES along with conventional physiotherapy showed better improvement in hand functions in the acute stroke survivals.

Download Full-text

Recovery of hand function with robot-assisted therapy in acute stroke patients

International Journal of Rehabilitation Research ◽

10.1097/mrr.0000000000000059 ◽

2014 ◽

Vol 37 (3) ◽

pp. 236-242 ◽

Cited By ~ 46

Author(s):

Patrizio Sale ◽

Stefano Mazzoleni ◽

Valentina Lombardi ◽

Daniele Galafate ◽

Maria P. Massimiani ◽

...

Keyword(s):

Acute Stroke ◽

Hand Function ◽

Stroke Patients ◽

Robot Assisted

Download Full-text

Added-value of spasticity reduction to improve arm-hand skill performance in sub-acute stroke patients with a moderately to severely affected arm-hand

Neurorehabilitation ◽

10.3233/nre-201622 ◽

2021 ◽

pp. 1-16

Author(s):

Johan Anton Franck ◽

Rob Johannes Elise Marie Smeets ◽

Jule Elmanowski ◽

Karolien Renders ◽

Henk Alexander Maria Seelen

Keyword(s):

Botulinum Toxin ◽

Action Research ◽

Acute Stroke ◽

Grip Strength ◽

Botulinum Toxin A ◽

Hand Function ◽

Added Value ◽

Stroke Patients ◽

Toxin A ◽

Skill Performance

BACKGROUND AND OBJECTIVE: Stroke patients with a moderately to severely affected hand may be impeded in exploiting their full arm-hand training potential during rehabilitation due to spasticity. Reducing early signs of spasticity in sub-acute stroke patients may lead to improvements in arm-hand-function and arm-hand-skill-performance. METHODS: Single-case-experimental-design and meta-analysis. Ten sub-acute stroke patients (Modified-Ashworth-Scale:1 + to 3) participated. Training: 2x6 weeks, using a well-described arm-hand regime (therapy-as-usual). Botulinum-toxin was administered once within 5 weeks after onset of therapy-as-usual. Measures: Action-Research-Arm-Test, ABILHAND, Fugl-Meyer-Assessment, grip-strength, Motricity-Index. RESULTS: At group level, after baseline trend correction, adjusting for spontaneous recovery and therapy-as-usual effects, the added-value of botulinum-toxin-A on arm-hand-function and arm-hand-skill-performance was not confirmed. However, non-detrended data revealed significant improvements over time on arm-hand-function and arm-hand-skill-performance level (p≤0.037). Conversely, at individual level, after baseline trend correction, 7/10 patients improved on arm-hand-function: Fugl-Meyer-Assessment (N = 4; p≤0.019), grip-strength (N = 3; p≤0.014), Motricity-Index (N = 4; p≤0.002), whereas 6/10 patients improved on arm-hand-skill-performance: Action-Research-Arm-Test (N = 3; p≤0.042), ABILHAND (N = 5; p≤0.034). CONCLUSION: Application of botulinum-toxin-A may have an added-value in a substantial part of sub-acute stroke patients suffering from spasticity early post-stroke and who, at the point of therapy admission, display no dexterity. It may improve their arm-hand performance when combined with a well– defined therapy-as-usual.

Download Full-text