Early upper limb physiotherapy in stroke patients. Questions without answers

Abstract Stroke is still the most common cause of disability in Poland and in western countries. As many as 80% of patients report reduced upper limb function in the acute phase after stroke. It is estimated that only 5% to 20% of patients experience full functional recovery of an upper limb. In clinical practice, paretic upper limb stimulation after stroke is usually treated as of secondary importance. However, it constantly poses a challenge to physical therapists. The existing procedures do not provide detailed guidelines regarding upper limb rehabilitation model particularly in the first four weeks after stroke. It is hard to predict biological limitations and the effectiveness of upper limb rehabilitation. The aim of this work is to make an attempt at reviewing the knowledge of the current state of early upper limb physiotherapy, its intensity and strategy type as well as neurobiological foundations of the improvement process. Ample scientific evidence confirms that early post-stroke rehabilitation is crucial. There are relatively few foreign (and virtually no Polish) reports related to early upper limb rehabilitation that would take into account the type of exercises and their therapeutic dose. There are still no solid foundations for determining optimal intensity and type of upper limb rehabilitation (including physical and occupational therapy). There is a scarcity of extensive and uniform (in terms of research groups and tools) multicentre investigations aimed at defining an optimal model of upper limb rehabilitation at an early stage after stroke. Thus, a number of questions still remain unanswered.

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Arm function after stroke - can we make a difference?

South African Journal of Physiotherapy ◽

10.4102/sajp.v55i2.559 ◽

1999 ◽

Vol 55 (2) ◽

pp. 4-7 ◽

Cited By ~ 1

Author(s):

L. Fearnhead ◽

C. J. Eales ◽

V. U. Fritz

Keyword(s):

Motor Control ◽

Upper Limb ◽

Functional Disability ◽

Hand Function ◽

Review Of The Literature ◽

Limb Function ◽

Upper Limb Rehabilitation ◽

Upper Limb Function ◽

Recent Developments ◽

Limb Rehabilitation

Impairment of upper limb function is a significant cause of functional disability after stroke. Based on a review of the literature this paper defines upper limb function and highlights some of the relevant recent developments in neuropathology. The effects of changes in sensation, muscle recruitment and tone are described. Reliable and valid outcome measures of upper limb impairment and disability are listed. The principles of rehabilitation are described in terms of timing of rehabilitation, sensory reeducation, motor control and functional use. Questions are raised regarding the need for counselling for the loss of fine discriminative hand function and for research into this behavioural aspect of upper limb rehabilitation.

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ADAPTATION OF DASH OUTCOME MEASURES TO SLOVENIAN POPULATION - FUNCTIONALITY OF ARM, SHOULDER AND HAND

Slovenian Medical Journal ◽

10.6016/zdravvestn.1043 ◽

2015 ◽

Vol 84 (2) ◽

Author(s):

Katja Semprimožnik ◽

Ernest Novak

Keyword(s):

Cultural Differences ◽

Outcome Measures ◽

Upper Limb ◽

Hand Function ◽

Upper Limb Rehabilitation ◽

Upper Limb Function ◽

Medical Centers ◽

Slovenian Population ◽

Limb Rehabilitation ◽

Work And Health

ABSTRACT BackgroundIn Slovenia, there is no test for upper limb function, which would be uniform for all institutions and would allow comparison of results of the therapy and upper limb rehabilitation with medical centers. MethodsAfter reviewing the existing hand function tests and current literature we decided to translate the DASH test - Disabilities of arm, shoulder and hand. Adaptation was tested on patient population in outpatient hand clinic, General hospital Celje and showed good validity, reliability and responsiveness. Results and discussionAdaptation of DASH test to Slovene population is a procedure, where language and cultural differences must be considered. Testing the adapted DASH in the general population shows good validity, reliability and responsiveness of adapted test. ConclusionTranslations DASH test, QuickDASH test and instructions for scoring the DASH outcome measures are approved by the Institute for Work and Health. Translations are published on their site and available for use.

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Early upper limb rehabilitation after stroke: A study of current upper limb use and the influence of increased upper limb use on post-stroke recovery

10.14264/c32fdbb ◽

2021 ◽

Author(s):

◽

Lay Fong Chin

Keyword(s):

Upper Limb ◽

Stroke Recovery ◽

Upper Limb Rehabilitation ◽

Post Stroke ◽

Limb Rehabilitation ◽

Early Upper

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Bilateral Upper Limb Training With Functional Electric Stimulation in Patients With Chronic Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308326428 ◽

2008 ◽

Vol 23 (4) ◽

pp. 357-365 ◽

Cited By ~ 55

Author(s):

Marko Ka-leung Chan ◽

Raymond Kai-yu Tong ◽

Kenneth Yiu-kwan Chung

Keyword(s):

Occupational Therapy ◽

Range Of Motion ◽

Upper Limb ◽

Electric Stimulation ◽

Control Group ◽

Wrist Extension ◽

Upper Limb Rehabilitation ◽

Upper Limb Function ◽

Active Range Of Motion ◽

Limb Rehabilitation

Background. The recovery rate of upper limb function after stroke is poor when compared with independent walking. Therefore, effective methods are warranted for upper limb rehabilitation. Objective. The aim of this study was to investigate the effectiveness of functional electric stimulation (FES) with bilateral activities training on upper limb function. Methods. This study was a double-blinded randomized controlled trial. Twenty patients were recruited 6 months after the onset of stroke and completed 15 training sessions. Participants were randomly assigned to the FES group or to the control group. Each session consisted of stretching activities (10 minutes), FES with bilateral tasks (20 minutes), and occupational therapy treatment (60 minutes). The participants used a self-trigger mechanism, with an accelerometer as a motion detector, for generating an electric stimulation pattern that was synchronized with the bilateral upper limb activities during the training. The participants in the control group received the same duration of stretching and occupational therapy training except that they just received placebo stimulation with the bilateral tasks. The outcome measures included Functional Test for the Hemiplegic Upper Extremity (FTHUE), Fugl—Meyer Assessment (FMA), grip power, forward reaching distance, active range of motion of wrist extension, Functional Independence Measure, and Modified Ashworth Scale. Results. At baseline comparison, there was no significant difference in both groups. After 15 training sessions, the FES group had significant improvement in FMA ( P = .039), FTHUE ( P = .001), and active range of motion of wrist extension ( P = .020) when compared with the control group. Conclusions. Bilateral upper limb training with FES could be an effective method for upper limb rehabilitation of stroke patients after 15 training sessions.

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Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168708 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8708

Author(s):

Zhenxuan Zhang ◽

Boris I. Prilutsky ◽

Andrew J. Butler ◽

Minoru Shinohara ◽

Maysam Ghovanloo

Keyword(s):

Upper Extremity ◽

Upper Limb ◽

Assistive Device ◽

Preliminary Evaluation ◽

Upper Limb Rehabilitation ◽

Upper Limb Function ◽

Tracking Tasks ◽

Arm Reaching ◽

Upper Extremity Impairment ◽

Limb Rehabilitation

Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23–60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.

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