Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial

Objective: The aim of this study was to compare the effects of two kinds of wrist-hand orthosis on wrist flexor spasticity in chronic stroke patients. Design: This is a randomized controlled trial. Setting: The study was conducted in a rehabilitation center. Participants: A total of 40 chronic hemiparetic stroke patients with wrist flexor spasticity were involved in the study. Interventions: Patients were randomly assigned to either an experimental group (conventional rehabilitation therapy + 3D-printed orthosis, 20 patients) or a control group (conventional rehabilitation therapy + low-temperature thermoplastic plate orthosis, 20 patients). The time of wearing orthosis was about 4–8 hours per day for six weeks. Main measures: Primary outcome measure: Modified Ashworth Scale was assessed three times (at baseline, three weeks, and six weeks). Secondary outcome measures: passive range of motion, Fugl-Meyer Assessment score, visual analogue scale score, and the swelling score were assessed twice (at baseline and six weeks). The subjective feeling score was assessed at six weeks. Results: No significant difference was found between the two groups in the change of Modified Ashworth Scale scores at three weeks (15% versus 25%, P = 0.496). At six weeks, the Modified Ashworth Scale scores (65% versus 30%, P = 0.02), passive range of wrist extension ( P < 0.001), ulnar deviation ( P = 0.028), Fugl-Meyer Assessment scores ( P < 0.001), and swelling scores ( P < 0.001) showed significant changes between the experimental group and the control group. No significant difference was found between the two groups in the change of visual analogue scale scores ( P = 0.637) and the subjective feeling scores ( P = 0.243). Conclusion: 3D-printed orthosis showed greater changes than low-temperature thermoplastic plate orthosis in reducing spasticity and swelling, improving motor function of the wrist and passive range of wrist extension for stroke patients.

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Acupuncture with Rehabilitation in the Treatment of Ischemic Stroke Recovery: A Randomized Controlled Trial

10.21203/rs.2.177/v2 ◽

2019 ◽

Author(s):

Lixia Li ◽

Weifeng Zhu ◽

Guohua Lin ◽

Chuyun Chen ◽

Donghui Tang ◽

...

Keyword(s):

Ischemic Stroke ◽

Controlled Trial ◽

Stroke Recovery ◽

Control Group ◽

Acupuncture Points ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Scale Scores ◽

Before And After ◽

Ashworth Scale

Abstract Background: Acupuncture is a well known treatment for ischemic stroke recovery, but evidence of its effectiveness remains limited. Methods: Rehabilitation training was provided to a control group. In Arm 1 and Arm 2, acupoint schemes were determined by a consensus of acupuncture experts and previous clinical research. Arm 1 was based on an acupoint summary of ancient literature, and Arm 2 was based on the summary of effective acupuncture points from modern RCT literature. Acupuncture was given on the acupoint. After acupuncture, the needles were left in for 30 minutes, and checked every 10 minutes. The three groups received treatment once a day, 5 times a week, for 2 weeks. The primary outcome was the National Institute of Health stroke scale (NIHSS), and the secondary outcomes were the Barthel index (BI) and the modified Ashworth scale (MAS). Outcomes were observed in patients both before and after treatment. Results: A total of 497 patients with ischemic stroke were randomized into either Arm 1 (159 cases), Arm 2 (173 cases) or a control group (165 cases). After 2 weeks of treatment, the NIHSS scores for Arm 1 were lower than those of the control group (P=0.017); the BI scores were higher in Arm 2 than they were in the control group (P=0.020). Additionally, there was no significant difference between Arm 1 and the control group for either the BI scores or the modified Ashworth scale scores (P>0.05). Conclusion: The clinical efficacy of Arm 1 and Arm 2 (acupuncture groups) was superior to that of the control group.

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Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: a prospective multicenter randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215516663009 ◽

2016 ◽

Vol 31 (7) ◽

pp. 904-912 ◽

Cited By ~ 4

Author(s):

Yu-jie Yang ◽

Jun Zhang ◽

Ying Hou ◽

Bao-yin Jiang ◽

Hua-fei Pan ◽

...

Keyword(s):

Barthel Index ◽

Therapy Group ◽

Massage Therapy ◽

Control Group ◽

Post Stroke ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Multicenter Randomized Controlled Trial ◽

Muscle Groups ◽

Ashworth Scale

Objective: To evaluate the effectiveness and safety of Chinese massage therapy (Tui Na) for patients with post-stroke spasticity. Design: A prospective, multicenter, blinded, randomized, placebo-controlled intervention trial. Subject: A total of 90 patients with post-stroke spasticity were randomly assigned to the experimental (Tui Na therapy) group ( n = 45) or control (placebo Tui Na therapy) group ( n = 45). Intervention: Participants in the experimental group received Tui Na therapy, while those in the control group received placebo-Tai Na (gentle rubbing) for 20–25 minutes per limb, once per day, five days per week for a total of four weeks. All participants in both groups received conventional rehabilitation. Main measure: The Modified Ashworth Scale, the Fugl-Meyer Assessment and the Modified Barthel Index were used to assess the severity of spasticity, motor function of limbs and activities of daily living, respectively. Assessments were performed at baseline, at four weeks and at three months. Results: Tui Na group had a significantly greater reduction in Modified Ashworth Scale in only four muscle groups than the control did (elbow flexors, P = 0.026; wrist flexors, P = 0.005; knee flexors, P = 0.023; knee extensors, P = 0.017). Improvements were sustained at three months follow-up. There was no significant difference between the two groups in Fugl-Meyer Assessment ( P = 0.503) and Modified Barthel Index ( P = 0.544). No adverse reaction was recorded in any of the cases mentioned at all study sites. Conclusions: Tui Na might be a safe and effective treatment to reduce post-stroke spasticity of several muscle groups.

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Impact of troponin I on outcome of ischemic stroke patients

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0044 ◽

2017 ◽

Vol 55 (1) ◽

pp. 19-22

Author(s):

Hrvoje Budincevic ◽

Josip Sremec ◽

Petra Crnac ◽

Vedran Ostojic ◽

Edvard Galic ◽

...

Keyword(s):

Ischemic Stroke ◽

Troponin I ◽

Control Group ◽

Elevated Troponin ◽

Stroke Patients ◽

Exclusion Criteria ◽

Coronary Syndrome ◽

Significant Difference ◽

Scale Scores ◽

Cardiac Troponins

Abstract Introduction. Stroke is one of the leading causes of morbidity and mortality. Cardiac troponins have been found to be increased in other conditions apart from the cardiac diseases, such as stroke. The aim of the study was to assess the correlation between elevated troponin I levels and stroke outcome. Methods. This retrospective study included 198 acute ischemic stroke patients in whom troponin I levels have been obtained at admission. Exclusion criteria were concomitant acute coronary syndrome, congestive heart failure, pulmonary embolism, renal failure, rhabdomyolysis and septic conditions. Results. There was a statistically significant difference in the proportion of deaths during hospitalization (p = 0.041) and modified Rankin Scale scores (p = 0.016) between the group of patients with elevated troponin I levels and the control group. Prior ischemic strokes were more common in the group with elevated troponin I levels (p = 0.032). No other differences were observed. Conclusions. Our study showed that patients with elevated initial troponin I levels are associated with unfavorable outcome or death. Stroke may be associated with mild elevation of troponin levels, contrary to higher levels which are usually related to other conditions.

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Antispastic Effect of Electroacupuncture and Moxibustion in Stroke Patients

The American Journal of Chinese Medicine ◽

10.1142/s0192415x03001077 ◽

2003 ◽

Vol 31 (03) ◽

pp. 467-474 ◽

Cited By ~ 28

Author(s):

Sang-Kwan Moon ◽

Yeon-Kyu Whang ◽

Sung-Uk Park ◽

Chang-Nam Ko ◽

Young-Suk Kim ◽

...

Keyword(s):

Electrical Stimulation ◽

Motor Impairment ◽

Control Group ◽

Stroke Patients ◽

Paretic Side ◽

Modified Ashworth Scale ◽

Significant Change ◽

And Control ◽

Ashworth Scale ◽

Efficacy Of Treatment

Spasticity is a frequently observed motor impairment that develops after stroke. The objective of this study was to evaluate the efficacy of electroacupuncture (EA) and moxibustion (Mox) on spasticity due to stroke. The subjects consisted of 35 stroke patients with elbow spasticity whose mean duration of stroke was 2.97 months. Fifteen patients were randomized to the EA group, ten to Mox, and ten to control. Every other day, 30 minutes of electrical stimulation with a frequency of 50 Hz was given through four needles on the Ch'ü-Ch'ih-San-Li (LI-11-LI-10) and Wai-Kuan-Ho-Ku (TB-5-LI-4) points of the paretic side. Direct Mox was applied to Ch'ü-Ch'ih (LI-11), San-Li (LI-10), Wai-Kuan (TB-5) and Ho-Ku (LI-4) points three times a day every other day. The control group was given only the routine acupuncture therapy for stroke and range of motion (ROM) exercise, which were also applied to the EA and Mox groups. The efficacy of treatment was measured before, immediately, 1 hour, 3 hours, 1 day, 5 days, 10 days and 15 days after the start of treatment using a modified Ashworth scale (MAS). In the EA group, spasticity was significantly reduced immediately, 1 hour and 3 hours after treatment (p < 0.05). Reductions were significant on the 5th day and thereafter (p < 0.05). In the Mox group, there was no significant change in the MAS scores after the first treatment. In the Mox and control group, there was no significant change in MAS scores. This study suggests that EA can temporarily reduce spasticity due to stroke, and if applied repeatedly it can maintain reduced spasticity.

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Acupuncture versus Rehabilitation in the Treatment of Ischemic Stroke Recovery: A Randomized Controlled Trial

10.21203/rs.2.177/v1 ◽

2019 ◽

Author(s):

Lixia Li ◽

Weifeng Zhu ◽

Guohua Lin ◽

Chuyun Chen ◽

Donghui Tang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Ischemic Stroke ◽

Controlled Trial ◽

Stroke Recovery ◽

Control Group ◽

Acupuncture Points ◽

Randomized Controlled ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Ashworth Scale

Abstract Background: Acupuncture is a treatment for ischemic stroke recovery, but evidence of its effectiveness remains limited. Methods: A total of 497 patients with ischemic stroke were randomized into Arm 1 (159 cases), Arm 2 (173 cases) and a control group (165 cases). In the control group, rehabilitation training was provided. In Arm 1 and Arm 2, acupoint schemes were determined by the consensus of acupuncture experts and previous clinical research. Arm 1 was based on an acupoint summary of ancient literature, and Arm 2 was based on the summary of effective acupuncture points in modern RCT literature. The treatment was given with conventional acupuncture at the appropriate position. After acupuncture, the needles were left in for 30 minutes, and checked every 10 minutes. The three groups received treatment once a day, 5 times a week, for 2 weeks. The primary outcome were the National Institute of Health stroke scale (NIHSS), and the secondary outcomes were the Barthel index (BI) and modified Ashworth scale (MAS). Outcomes were observed in patients both before and after treatment. Results: After 2 weeks of treatment, there was no significant difference between Arm 1 and the control group for either the BI scores or the modified Ashworth scale scores (P>0.05). However, the NIHSS scores of Arm 1 were lower than those of the control group (P=0.017); the BI scores were higher in Arm 2 than they were in the control group (P=0.020). Conclusion: The clinical efficacy of Arm 1 and Arm 2 (acupuncture groups) was superior to that of the control group. Trial Registration: Chinese Clinical Trial Registry: ChiCTR-IOR-16008627, Registered 11 June 2016, http://www.chictr.org.cn/index.aspx. Keywords: Acupuncture; ischemic stroke; randomized controlled trial (RCT)

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The Value of Real-Time Shear Wave Elastography before and after Rehabilitation of Upper Limb Spasm in Stroke Patients

BioMed Research International ◽

10.1155/2020/6472456 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Jun Liu ◽

Huijuan Pan ◽

Yong Bao ◽

Yanna Zhao ◽

Li Huang ◽

...

Keyword(s):

Shear Wave ◽

Upper Limb ◽

Biceps Brachii ◽

Shear Wave Elastography ◽

Stroke Patients ◽

Rehabilitation Treatment ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Before And After ◽

Ashworth Scale

Objective. Our goal was to evaluate the efficacy of muscle spasm before and after rehabilitation by comparing shear wave propagation velocity (SWV) and Young’s modulus (YM) in the normal and spastic biceps brachii in stroke patients. Methods. A study of 60 stroke patients with upper limb spasm was performed; these patients were admitted from April 2018 to September 2019. The modified Ashworth scale (MAS) scores of the spastic biceps brachii before and after rehabilitation treatment were compared. SWV and YM on the spastic and normal biceps brachii before rehabilitation treatment, SWV and YM on the spastic and normal biceps brachii after rehabilitation treatment, and SWV and YM on the spastic biceps brachii before and after rehabilitation treatment were compared. Whether SWV and YM on the spastic biceps brachii are related to MAS was compared. Results. There was a statistically significant difference in SWV and YM between the normal and spastic biceps brachii before (P<0.01) and after (P<0.05) the rehabilitation treatment. There was no statistically significant difference in SWV and YM in the normal biceps brachii before and after the rehabilitation treatment (P>0.05). There was a statistically significant difference in SWV and YM in the spastic biceps brachii before and after the rehabilitation treatment (P<0.01). SWV and FM of the spastic biceps brachii are correlated with MAS before and after rehabilitation treatment, and the correlation coefficient for SWV was 0.563 and 0.605 for YM (P<0.05). Conclusion. SWE can be used as a means of assessment before and after rehabilitation treatment.

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An effective approach for botulinum toxin injection in patients with stroke for focal spasticity: dual guidance

Medical Science and Discovery ◽

10.36472/msd.v5i9.269 ◽

2018 ◽

Vol 5 (9) ◽

pp. 326-330

Author(s):

Emre Ata ◽

Murat Kosem

Keyword(s):

Botulinum Toxin ◽

Upper Limb ◽

Botulinum Toxin Injection ◽

Stroke Patients ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Limb Muscles ◽

Botulinum Toxin Injections ◽

Ashworth Scale ◽

Electrical Muscle

Objective: This study has aimed to compare the efficacy of botulinum toxin (BTX) injections, applied to the upper limb muscles of the stroke patients in our clinic who have being diagnosed with focal spasticity, that are performed via ultrasonography and ultrasonography + electrical muscle (EM) stimulator guidance. Literature didn’t include detailed crosscheck of ultrasound guided BTX and EM treatment applications for upper limb focal spasticity patients Materials and Methods: Electronic data on 62 hemiplegic stroke patients with grade 2 and 3 focal spasticity who had received botulinum toxin injections into their upper limb muscles by the same physician, who used similar protocol and recorded the results, were scanned retrospectively. The spasticity of the patients in both groups was assessed with the Modified Ashworth Scale at the end of two weeks and three months. Results: A statistically significant difference was found between the Modified Ashworth Scale values of both groups in terms of all muscles, compared to the values seen in the pre-treatment period (p<0.05). The Modified Ashworth Scale values at 3 months posttreatment in ultrasonography + electrical muscle stimulator group were not statistically different from those at 2 weeks posttreatment, with respect to wrist flexion and finger flexion. In intergroup comparison, there was no statistically significant difference between the Modified Ashworth Scale values of at pretreatment and 2 weeks posttreatment. However, statistically significant difference in all muscle groups was found in favor of the ultrasonography + electrical muscle stimulator group at 3 months posttreatment controls (p<0.05). Conclusion: Upper limb spasticity due to stroke can be substantially recovered with botulinum toxin injections that are applied via only ultrasonography guidance or via ultrasonography + electrical muscle stimulator guidance.. According to data from the assessment at 3 months posttreatment, the botulinum toxin injection performed via ultrasonography + electrical muscle stimulator guidance had more positive effects .

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Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020583 ◽

2021 ◽

Vol 18 (2) ◽

pp. 583

Author(s):

Reem M. Alwhaibi ◽

Noha F. Mahmoud ◽

Mye A. Basheer ◽

Hoda M. Zakaria ◽

Mahmoud Y. Elzanaty ◽

...

Keyword(s):

Physical Therapy ◽

Lower Extremity ◽

Functional Recovery ◽

Intervention Group ◽

Chronic Stroke ◽

Post Treatment ◽

Control Group ◽

Stroke Patients ◽

Significant Difference ◽

Group Post

Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for “Cz-AR”, compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.

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Clinical Efficacy of a New Robot-assisted Gait Training System for Acute Stroke Patients

Journal of Medical and Biological Engineering ◽

10.1007/s40846-020-00590-z ◽

2021 ◽

Author(s):

Andy Chien ◽

Fei-Chun Chang ◽

Nai-Hsin Meng ◽

Pei-Yu Yang ◽

Ching Huang ◽

...

Keyword(s):

Sleep Quality ◽

Acute Stroke ◽

Quality Index ◽

Pittsburgh Sleep Quality Index ◽

Gait Training ◽

Training System ◽

Control Group ◽

Stroke Patients ◽

Robot Assisted ◽

Significant Difference

Abstract Purpose Robot-assisted gait rehabilitation has been proposed as a plausible supplementary rehabilitation strategy in stroke rehabilitation in the last decade. However, its exact benefit over traditional rehabilitation remain sparse and unclear. It is therefore the purpose of the current study to comparatively investigate the clinical benefits of the additional robot-assisted training in acute stroke patients compared to standard hospital rehabilitation alone. Methods Ninety acute stroke patients (< 3 month) were recruited. All participants received the standard hospital neurorehabilitation comprises 45–60 min sessions daily for 3 weeks. Sixty patients also received an additional 30 min of robot-assisted gait training with the HIWIN MRG-P100 gait training system after each of the standard neurorehabilitation session. Outcome measures included: 1. Berg Balance Scale (BBS); 2. Brunnstrom Stage; 3. Pittsburgh Sleep Quality Index and 4. Taiwanese Depression Questionnaire (TDQ) which were assessed pre-treatment and then after every five training sessions. Results Both groups demonstrated significant improvement pre- and post-treatment for the BBS (robotic group p = 0.023; control group p = 0.033) but no significant difference (p > 0.1) between the groups were found. However, the robotic training group had more participants demonstrating larger BBS points of improvement as well as greater Brunnstrom stage of improvement, when compared to the control group. No significant within and between group statistical differences (p > 0.3) were found for Pittsburgh Sleep Quality Index and Taiwanese Depression Questionnaire. Conclusion The addition of robotic gait training on top of standard hospital neurorehabilitation for acute stroke patients appear to produce a slightly greater improvement in clinical functional outcomes, which is not transferred to psychological status.

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