Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: a randomized controlled pilot study

Purpose. To compare the effectiveness of contralaterally controlled functional electrical stimulation (CCFES) versus neuromuscular electrical stimulation (NMES) on motor recovery of the upper limb in subacute stroke patients. Materials and Methods. Fifty patients within six months poststroke were randomly assigned to the CCFES group ( n = 25 ) and the NMES group ( n = 25 ). Both groups underwent routine rehabilitation plus 20-minute stimulation on wrist extensors per day, five days a week, for 3 weeks. Fugl-Meyer Assessment of upper extremity (FMA-UE), action research arm test (ARAT), Barthel Index (BI), and surface electromyography (sEMG) were assessed at baseline and end of intervention. Results. After a 3-week intervention, FMA-UE and BI increased in both groups ( p < 0.05 ). ARAT increased significantly only in the CCFES group ( p < 0.05 ). The changes of FMA-UE, ARAT, and BI in the CCFES group were not greater than those in the NMES group. The improvement in sEMG response of extensor carpi radialis by CCFES was greater than that by NMES ( p = 0.026 ). The cocontraction ratio (CCR) of flexor carpi radialis did not decrease in both groups. Conclusions. CCFES improved upper limb motor function, but did not show better treatment effect than NMES. CCFES significantly enhanced the sEMG response of paretic extensor carpi radialis compared with NMES, but did not decrease the cocontraction of antagonist.

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Modified Constraint-Induced Therapy in Acute Stroke: A Randomized Controlled Pilot Study

Neurorehabilitation and Neural Repair ◽

10.1177/1545968304272701 ◽

2005 ◽

Vol 19 (1) ◽

pp. 27-32 ◽

Cited By ~ 137

Author(s):

Stephen J. Page ◽

Peter Levine ◽

Anthony C. Leonard

Keyword(s):

Pilot Study ◽

Acute Stroke ◽

Upper Limb ◽

Motor Deficits ◽

Stroke Patients ◽

Rehabilitation Hospital ◽

Randomized Controlled ◽

Hospital Patients ◽

Upper Limb Hemiparesis ◽

And Function

To determine modified constraint-induced therapy (mCIT) feasibility and compare its efficacy to traditional rehabilitation (TR) in acute stroke patients exhibiting upper limb hemiparesis. Method. Before-after, multiple baseline, randomized controlled pilot study. Setting. Rehabilitation hospital. Patients. Ten stroke patients < 14 d poststroke and exhibiting upper limb hemiparesis and affected limb nonuse. Interventions. Five patients were administered mCIT, consisting of structured therapy emphasizing more affected arm use in valued activities 3 d/week for 10 weeks and less affected arm restraint 5 d/week for 5 h. Five other patients received 1/2 sessions of traditional motor rehabilitation for the affected arm, which included affected limb manual dexterity exercises and stretching, as well as compensatory strategies with the unaffected limb. The TR regimens occurred 3 d/week for 10 weeks. Main Outcome Measures. The Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer), Action Research Arm Test (ARA), and Motor Activity Log (MAL). Results. Before intervention, all patients exhibited stable motor deficits and more affected arm nonuse. After intervention, mCIT patients displayed increased affected arm use (+ 2.43 on the MAL amount of use scale), uniformly exhibited increases on the Fugl-Meyer and ARA (mean change scores = + 18.7 and + 21.7, respectively), and were able to again perform valued activities. TR patients exhibited nominal change in affected limb use (+ 0.07 on the MAL amount of use scale) and modest changes on the Fugl-Meyer and ARA (+ 4.4 and + 4.8, respectively). Fugl-Meyer and ARA changes were significant for the mCIT group only (P < 0.01). Conclusions. mCIT is a promising regimen for improving more affected limb use and function in acute cerebrovascular accident. However, larger confirmatory studies need to be performed.

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