Changes in motor paralysis involving upper extremities of outpatient chronic stroke patients from temporary rehabilitation interruption due to spread of COVID-19 infection: An observational study on pre- and post-survey data without a control group

Background Outpatient rehabilitation was temporarily suspended because of coronavirus disease (COVID-19), and there was a risk that patients’ activities of daily living (ADLs) would decrease and physical functions unmaintained. Therefore, we investigated the ADLs and motor functions of chronic stroke patients whose outpatient rehabilitation was temporarily interrupted. Methods In this observational study, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and Barthel Index (BI) scores of 49 stroke hemiplegic patients at 6 and 3 months before rehabilitation interruptions were retrospectively determined and were prospectively investigated on resumption of outpatient rehabilitation. Presence or absence of symptoms and difficulties caused by the interruption period (IP) was investigated using a binomial method. Deltas were analyzed using a generalized linear model (GLM) according to the survey period. Age, sex, severity of FMA-UE immediately post-resumption and post-onset period were used as covariates. For survey items showing significant model fit, the 95% confidence interval of minimum detectable change (MDC95) was calculated, and the amount of change was compared. Questionnaire responses were tested via proportion ratio. Statistical significance was set at 5%. Results The FMA-UE part A and total scores were significantly model fit depending on periods. The estimated FMA-UE total score decreased by 1.64 (z = −2.38, p = 0.02) during the 3-month IP. No fits were observed by GLM in other parts of the FMA-UE, ARAT, or BI. The calculated MDC95 was 3.58 for FMA-UE part A and 4.50 for FMA-UE overall. Answers to questions regarding sleep disturbance and physical pain were significantly biased toward “no” in the psychosomatic function items (p<0.05). There was no bias in the distribution of answers to questions regarding joint stiffness, muscle weakness, muscle stiffness, and difficulty in moving arms and hands. All 16 questions regarding activities and participation items were significantly biased toward answers “no” (p<0.05). Conclusions The FMA-UE part A and total scores were affected. Patients complained of subjective symptoms related to upper limb paralysis after the IP. Since ADLs of patients were maintained, the therapist can recommend that patients not receiving outpatient treatments be evaluated in relation to the shoulder, elbow, and forearm and instructed on self-training to maintain motor function.

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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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Movement-Related EEG Oscillations of Contralesional Hemisphere Discloses Compensation Mechanisms of Severely Affected Motor Chronic Stroke Patients

International Journal of Neural Systems ◽

10.1142/s0129065721500532 ◽

2021 ◽

Author(s):

Juan A. Barios ◽

Santiago Ezquerro ◽

Arturo Bertomeu-Motos ◽

Jose M. Catalan ◽

Jose M. Sanchez-Aparicio ◽

...

Keyword(s):

Motor Cortex ◽

Time Course ◽

Chronic Stroke ◽

Cortical Activation ◽

Motor Deficit ◽

Control Group ◽

Detailed Knowledge ◽

Stroke Patients ◽

Stroke Treatment ◽

Compensation Mechanisms

Conventional rehabilitation strategies for stroke survivors become difficult when voluntary movements are severely disturbed. Combining passive limb mobilization, robotic devices and EEG-based brain-computer interfaces (BCI) systems might improve treatment and clinical follow-up of these patients, but detailed knowledge of neurophysiological mechanisms involved in functional recovery, which might help for tailoring stroke treatment strategies, is lacking. Movement-related EEG changes (EEG event-related desynchronization (ERD) in [Formula: see text] and [Formula: see text] bands, an indicator of motor cortex activation traditionally used for BCI systems), were evaluated in a group of 23 paralyzed chronic stroke patients in two unilateral motor tasks alternating paretic and healthy hands ((i) passive movement, using a hand exoskeleton, and (ii) voluntary movement), and compared to nine healthy subjects. In tasks using unaffected hand, we observed an increase of contralesional hemisphere activation for stroke patients group. Unexpectedly, when using paralyzed hand, motor cortex activation was reduced or absent in severely affected group of patients, while patients with moderate motor deficit showed an activation greater than control group. Cortical activation was reduced or absent in damaged hemisphere of all the patients in both tasks. Significant differences related to severity of motor deficit were found in the time course of [Formula: see text] bands power ratio in EEG of contralesional hemisphere while moving affected hand. These findings suggest the presence of different compensation mechanisms in contralesional hemisphere of stroke patients related to the grade of motor disability, that might turn quantitative EEG during a movement task, obtained from a BCI system controlling a robotic device included in a rehabilitation task, into a valuable tool for monitoring clinical progression, evaluating recovery, and tailoring treatment of stroke patients.

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Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke

BMC Neurology ◽

10.1186/s12883-019-1503-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Lena Rafsten ◽

Anna Danielsson ◽

Asa Nordin ◽

Ann Björkdahl ◽

Asa Lundgren-Nilsson ◽

...

Keyword(s):

Multidisciplinary Team ◽

Controlled Trial ◽

Stroke Care ◽

Secondary Outcome ◽

Outpatient Rehabilitation ◽

Control Group ◽

Stroke Patients ◽

Post Stroke ◽

Early Supported Discharge ◽

Significant Difference

Abstract Background and purpose Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. Methods A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS). Results No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. Conclusions The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. Trial registration Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

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Effectiveness of community rehabilitation for chronic stroke patients—effect factors of outpatient rehabilitation class

Physiotherapy ◽

10.1016/j.physio.2015.03.1955 ◽

2015 ◽

Vol 101 ◽

pp. e1069-e1070

Author(s):

E. Nakamata ◽

Y. Yuri ◽

K. Nagino ◽

K. Okamoto ◽

M. Nishii ◽

...

Keyword(s):

Chronic Stroke ◽

Outpatient Rehabilitation ◽

Stroke Patients ◽

Effect Factors ◽

Community Rehabilitation

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Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.6.599 ◽

2020 ◽

Vol 2 (6) ◽

Author(s):

Mohammed Tarek Alam ◽

Rubaiul Murshed ◽

Pauline Francisca Gomes ◽

Zafor Md. Masud ◽

Sadia Saber ◽

...

Keyword(s):

Observational Study ◽

Large Scale ◽

Statistical Significance ◽

Healthcare Providers ◽

Tertiary Hospital ◽

Control Group ◽

P Value ◽

Chi Square ◽

Exposure Prophylaxis ◽

Experimental Group

Introduction: While multiple vaccines are undergoing clinical trial across the globe, we yearn for an FDA approved drug to protect us from the devastating pandemic for the time being. This study aims to determine the effectiveness of Ivermectin when administered as pre-exposure prophylaxis for COVID-19. Method: An observational study, with 118 healthcare providers who were enrolled purposively, was conducted in a tertiary hospital in Dhaka from May 2020 to August 2020. The subjects were divided into experimental and control groups; and the experimental group received an oral monthly dose of Ivermectin 12mg for 4 months. Both groups were exposed to COVID-19 positive patients admitted in the hospital during the course of study. The symptomatic subjects were evaluated by physical examination, COVID-19 RT-PCR and/or HRCT of chest. Differences between the variables were determined using the Chi-square test and the level of statistical significance was reached when p<0.05. Result: 73.3% (44 out of 60) subjects in control group were positive for COVID-19, whereas only 6.9% (4 out of 58) of the experimental group were diagnosed with COVID-19 (p-value < 0.05). Conclusion: Ivermectin, an FDA-approved, safe, cheap and widely available drug, should be subjected to large-scale trials all over the world to ascertain its effectiveness as pre-exposure prophylaxis for COVID-19.

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Continuous hemodiafiltration as a rescue therapy for patients with cardiopulmonary failure caused by enterovirus-71: a retrospective observational study in a PICU

BMC Infectious Diseases ◽

10.1186/s12879-019-4519-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Chunxia Wang ◽

Yun Cui ◽

Yan Zhu ◽

Fei Wang ◽

Qunfang Rong ◽

...

Keyword(s):

Observational Study ◽

Statistical Significance ◽

Enterovirus 71 ◽

Left Ventricular ◽

Retrospective Observational Study ◽

Left Ventricular Ejection ◽

Control Group ◽

Continuous Hemodiafiltration ◽

Ventricular Ejection Fraction ◽

Cardiopulmonary Failure

Abstract Background Hand, foot and mouth disease (HFMD) remains a burdensome health issue in mainland China. Enterovirus71 (EV-A71) is the main pathogen of severe HFMD. Continuous hemofiltration improves fluid overload, restores kidney function and alleviates inflammatory reactions. The aim of the present study was to evaluate the effects of continuous veno-venous hemodiafiltration (CVVHDF) on severe HFMD caused by EV-A71(EV-A71-HFMD) in a pediatric intensive care unit (PICU). Methods A retrospective observational study was performed in a tertiary university PICU from January 2012 to December 2016. Children with severe EV-A71-HFMD complicated by cardiopulmonary failure were included. The patients were divided into a CVVHDF group and a conventional therapy (control) group (non-CVVHDF). The demographics, characteristics, and outcomes between the groups were collected and analyzed. Results Twenty-nine patients with severe EV-A71-HFMD were enrolled. The 28-day mortality was 17.6% (3/17) in the CVVHDF group and 33.3% (4/12) in the non-CVVHDF group, with no statistical significance between the two groups (P = 0.403). The median interval between CVVHDF initiation and PICU admission was 6 (4,8.5) hrs, and the median duration of CVVHDF was 48 (36, 64) hrs. The left ventricular ejection fraction (LVEF) and cardiac index (CI) in the CVVHDF group were improved after treatment. The plasma levels of catecholamines and renin-angiotensin-aldosterone system (RAAS) substances in the CVVHDF group were significantly decreased after treatment. The decreased catecholamines and RAAS substances included adrenalin (169.8 [145.5, 244.6] vs. 148.0 [109.0, 208.1] ng/L, P = 0.033), dopamine (152.7 [97.0, 191.1] vs. 96.0 [68.0, 160.9] ng/L, P = 0.026), angiotensin II (185.9 [125.2, 800.0] vs. 106.0 [90.8, 232.5] ng/L, P = 0.047), aldosterone (165.7 [94.0, 353.3] vs. 103.3 [84.3, 144.3] ng/L, P = 0.033), and renin (1.12 [0.74, 3.45] vs. 0.79 [0.52, 1.25] μg/L/h, P = 0.029), Conclusions CVVHDF reduced the levels of catecholamines and RAAS substances and improved cardiovascular function. Continuous hemodiafiltration may represent a potential therapy in patients with severe EV-A71-HFMD complicated with cardiopulmonary failure.

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Improvement of Hand Motor Function after Radial Shock Wave Therapy in Chronic Stroke Patients

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/2621-7678.07(1).01 ◽

2018 ◽

pp. 2-12

Author(s):

M Kamaluddin ◽

Erna Setiawati ◽

Tanti Ajoe Kesoema

Keyword(s):

Shock Wave ◽

Motor Function ◽

Controlled Trial ◽

Hand Function ◽

Chronic Stroke ◽

Control Group ◽

Shock Wave Therapy ◽

Stroke Patients ◽

And Control ◽

Experimental Group

Introduction: The Radial Shock Wave Therapy (RSWT) expected could improve spasticity and hand function in chronic stroke patients. This study aimed to find out the improvement of hand function after RSWT as an additional therapy in chronic stroke patients. Methods: Design study was a randomized controlled trial. The patients were assigned randomly to the experimental group (Infrared, Stretching, and RSWT) and control group (Infrared and Stretching) for six weeks. Hand motor function was measured using Fugl-Meyer Motor Assesment (FMA) before and after intervention. Conclusion: There were improvement of wrist and hand FMA scores in the experimental as well as control group Results: Median of wrist FMA scores in the experimental and control group before intervention were 2 and 3 respectively whereas median of wrist FMA scores in the experimental and control group after intervention were 5 and 4 respectively. Median of hand FMA scores in the experimental and control group before intervention were 4 and 4 respectively whereas median of hand FMA scores in the control and experimental group after intervention were 6 and 5 respectively. The scores of wrist- hand FMA in the control and experimental group after intervention were increased P = 0.001P < 0.001 (wrist) and P = 0.001 P < 0.001 (hand) respectively. However, difference increased of wrist and hand FMA scores in the experimental group after intervention were more significant. Keywords: Spasticity, Hand Function, Stroke, Radial Shock Therapy, Fugl-Meyer Motor Assesment

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Improvement of Hand Motor Function after Radial Shock Wave Therapy in Chronic Stroke Patients

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/2019.ikfr.07(1).01 ◽

2019 ◽

pp. 2-12

Author(s):

M. Kamaluddin K ◽

Erna Setiawati ◽

Tanti Ajoe Kesoema

Keyword(s):

Shock Wave ◽

Motor Function ◽

Hand Function ◽

Chronic Stroke ◽

Control Group ◽

Shock Wave Therapy ◽

Stroke Patients ◽

Before And After ◽

And Control ◽

Experimental Group

IIntroduction: The Radial Shock Wave Therapy (RSWT) expected could improve spasticity and hand function in chronic stroke patients. This study aimed to find out the improvement of hand function after RSWT as an additional therapy in chronic stroke patients. Methods: Design study was a randomized controlled trial, in December 2018. The patients were assigned randomly to the experimental group (Infrared, Stretching, and RSWT) and control group (Infrared and Stretching) for six weeks. Hand motor function was measured using Fugl-Meyer Motor Assesment (FMA) before and after intervention. Results: The median values of wrist FMA scores in the experimental and control group before and after intervention were 2 vs 5 (p=0.001) and 3 vs 4 (p<0.001) respectively. The median values of hand FMA scores in the experimental and control group before and intervention were 4 vs 6 (p=0,.001) and 4 vs 5 (p<0.001). However, the delta between before and after intervention was higher in experimental group. Conclusion: The improvement of wrist and hand FMA scores after added treatment by RSWT was tend to higher.Keywords: Spasticity, Hand Function, Stroke, Radial Shock Therapy, Fugl-Meyer Motor Assesment

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Effects of Biaxial Ankle Strengthening on Muscle Efficiency during Gait in Chronic Stroke Patients: A Randomized Controlled Pilot Study

10.21203/rs.3.rs-19660/v1 ◽

2020 ◽

Author(s):

Ji-Eun Cho ◽

Wan-Hee Lee ◽

Joon-Ho Shin ◽

Hogene Kim

Keyword(s):

Visual Feedback ◽

Isometric Contraction ◽

Walking Speed ◽

Chronic Stroke ◽

Foot Drop ◽

Control Group ◽

Stroke Patients ◽

Randomized Controlled ◽

Ankle Muscle ◽

Ankle Strength

Abstract Background: Ankle dysfunction in stroke patients is a common but serious cause of balance and gait impairment. However there seldom exists comprehensive paretic ankle training. Thus we investigated the effects of biaxial ankle muscle training (AMT) using visual feedback as a means to improve ankle strength and functional activities in stroke patients. Methods: The study design was a randomized controlled pilot trial with concealed allocation and assessor blinding, and intention-to-treat analysis. Twenty-five patients with stroke under inpatient rehabilitation with difficulty walking (e.g. foot drop), or ankle muscle weakness participated. The experimental group underwent AMT consisting of passive stretching, contraction to match movement, and active-resistive strengthening using visual feedback for 40 minutes per day, 5 times per week for 4 weeks. The control group underwent ankle-related physical therapy including ankle range of motion(ROM) exercises for matched time period. The outcomes were ankle isometric contraction force, Fugl-Meyer lower extremity (FM-L), Berg balance scale (BBS), walking speed, and ankle co-contraction index (CI) during gai. Results: The results showed significant between-group differences for ankle isometric contraction in each direction (P<0.05), FM-L (P<0.01) and stance-phase CI (P<0.05). Post training, the AMT group displayed significant differences in the ankle isometric contraction in each direction (P<0.01), ankle proprioception (P<0.05), and walking speed (P<0.05). Conclusions: Our findings demonstrate the significant short-term effects of AMT on ankle strength, walking speed, and ankle muscle efficiency in chronic stroke survivors.

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