Rehabilitation of upper extremity by telerehabilitation combined with exergames in chronic stroke survivors: Preliminary findings from a feasibility clinical trial (Preprint)

2021 ◽  
Author(s):  
Dorra Rakia Allegue ◽  
Johanne Higgins ◽  
Shane N Sweet ◽  
Philippe S Archambault ◽  
Francois Michaud ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Upper Extremity ◽  
Conventional Therapy ◽  
Chronic Stroke ◽  
Control Group ◽  
Stroke Survivors ◽  
Post Intervention ◽  
Experimental Group ◽  
At Home

BACKGROUND Exergames are increasingly used among stroke survivors with chronic UE sequelae, to continue exercising at home, after discharge, and maintain activity level. The use of virtual reality exergames combined with telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in chronic stroke survivors while allowing for ongoing monitoring with a clinician. OBJECTIVE 1) To determine the feasibility of using VirTele with chronic stroke survivors at home; 2) To explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation, in chronic stroke survivors, compared with conventional therapy (GRASP: Graded Repetitive Arm Supplementary Program). METHODS This is a feasibility clinical trial including a two-arm trial design. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility measurements included the number and active time spent on exergame sessions, frequency and time spent by the clinician during videoconferencing sessions, satisfaction with the technology, and resource utilization (equipment, technical support). Outcome measurements included the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Motor Activity log-30 (MAL), Stroke Impact Scale-16 (SIS), and Treatment Self-Regulation Questionnaire-15 (TSRQ) and were administered to both groups at four-time points: T1: before starting the intervention; T2: post-intervention; T3: one-month post-intervention and T4: two-months post-intervention. RESULTS A total of 11 stroke survivors were randomized and allocated to the treatment group. At the COVID-19 onset, participants pursued the allocated treatment for 3-months. VirTele intervention dose was captured in term of time spent on exergames (mean-8 weeks: 16.6 hours; SD 3.0 and mean-third month: 9.3 hours; SD 7.1), frequency of use of exergames (total-mean: 62,5; range: 49-84 sessions), and total number of successful repetitions (mean-8weeks: 13 683; SD 2367 and mean-third month:12035,5; SD 9508,46) and frequency of video-conference- sessions (total mean: 6,6 , range: 3-11 sessions). The technical issues included loss of passwords, Internet issues, updates of the system, and problems with the avatar. Overall, most stroke survivors found the technology easy to use and quite useful, except for one participant. For the FMA-UE and MAL, both groups exhibited an improvement in more than 50% of the participants, maintained over time. Regarding the SIS scores, the control group reported improvement in activities of daily life (60% (3/5)), hand function (100% (5/5)), and mobility (40% (2/5)), while the experimental group reported varied and non-conclusive results. For the TSRQ, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score, while in the control group this improvement was shown in only one participant. CONCLUSIONS VirTele intervention constitutes another therapeutic alternative, in addition to the conventional therapy to deliver an intense personalized rehabilitation program in chronic stroke survivors with UE sequelae. CLINICALTRIAL ClinicalTrials.gov NCT03759106; http://clinicaltrials.gov/show/NCT03759106. INTERNATIONAL REGISTERED REPORT RR2-10.2196/14629

scholarly journals Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Shih-Ching Chen ◽  
Chueh-Ho Lin ◽  
Sheng-Wen Su ◽  
Yu-Tai Chang ◽  
Chien-Hung Lai
Keyword(s):  
Pilot Study ◽  
Effect Size ◽  
Exercise Intervention ◽  
Chronic Stroke ◽  
Control Group ◽  
Stroke Survivors ◽  
Post Intervention ◽  
Timed Up And Go ◽  
Kinect Camera ◽  
Experimental Group

Abstract Background Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. Methods In this prospective case–control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. Results Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). Conclusion The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial

2021 ◽  
pp. 096452842110563
Author(s):  
Sandra Calvo ◽  
Natalia Brandín-de la Cruz ◽  
Carolina Jiménez-Sánchez ◽  
Elisabeth Bravo-Esteban ◽  
Pablo Herrero
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Upper Extremity ◽  
Chronic Stroke ◽  
Control Group ◽  
Sensorimotor Function ◽  
Single Session ◽  
Dry Needling

Background: Persons with stroke commonly have impairments associated with a reduction in functionality. Motor impairments are the most prevalent, causing an impact on activities of daily life. Objective: The aim of this study was to evaluate the effect of a session of dry needling (DN) applied to the upper extremity muscles on the sensorimotor function, hypertonia, and quality of life of persons with chronic stroke. Methods: A randomized, sham-controlled clinical trial was performed. Participants were randomly assigned into an intervention group that received a single session DN in the biceps brachii, brachialis, flexor digitorum superficialis and profundus, extensor digitorum, adductor pollicis and triceps brachii muscles, or into a control group that received the same treatment but with a sham DN intervention. Treatment outcomes included the Fugl–Meyer Assessment Scale for the upper extremity, the Modified Modified Ashworth Scale, and the EuroQol-5D questionnaire. Measurements were carried out before, immediately after, and 14 days after intervention. Results: Twenty-three persons participated in the study. Significant differences between groups were observed after the intervention in the total wrist–hand motor score (p = 0.023) and sensorimotor score (p = 0.022), for hypertonia in the elbow extensors both after treatment (p = 0.002) and at follow-up (p = 0.018), and in quality of life at follow-up (p = 0.030). Conclusions: A single session of DN improved total wrist–hand motor function and total sensorimotor function in persons with chronic stroke immediately after treatment, as well as quality of life 2 weeks after treatment. Trial registration number: NCT03546517 (ClinicalTrials.gov)

scholarly journals Effectiveness of a New 3D-Printed Dynamic Hand–Wrist Splint on Hand Motor Function and Spasticity in Chronic Stroke Patients

2021 ◽  
Vol 10 (19) ◽  
pp. 4549
Author(s):  
Yu-Sheng Yang ◽  
Chi-Hsiang Tseng ◽  
Wei-Chien Fang ◽  
Ia-Wen Han ◽  
Shyh-Chour Huang
Keyword(s):  
Intervention Program ◽  
Controlled Trial ◽  
Chronic Stroke ◽  
Ease Of Use ◽  
Control Group ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Dynamic Splint ◽  
Experimental Group ◽  
At Home

Spasticity, a common stroke complication, can result in impairments and limitations in the performance of activities and participation. In this study, we investigated the effectiveness of a new dynamic splint on wrist and finger flexor muscle spasticity in chronic stroke survivors, using a randomized controlled trial. Thirty chronic stroke survivors were recruited and randomly allocated to either an experimental or control group; 25 completed the 6-week intervention program. The participants in the experimental group were asked to wear the dynamic splint at least 6 h/day at home, for the entire intervention. The participants in the control group did not wear any splint. All the participants were evaluated 1 week before, immediately, and after 3 and 6 weeks of splint use, with the modified Ashworth scale and the Fugl−Meyer assessment for upper extremity. User experience was evaluated by a self-reported questionnaire after the 6-week intervention. The timed within-group assessments showed a significant reduction in spasticity and improvements in functional movements in the experimental group. We found differences, in favor of the experimental group, between the groups after the intervention. The splint users indicated a very good satisfaction rating for muscle tone reduction, comfort, and ease of use. Therefore, this new splint can be used for at-home rehabilitation in chronic stroke patients with hemiparesis.

scholarly journals Effects of a positive thinking program on hope and sleep quality in Iranian patients with thalassemia: a randomized clinical trial

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Somayeh Makaremnia ◽  
Marieh Dehghan Manshadi ◽  
Zahra Khademian
Keyword(s):  
Clinical Trial ◽  
Sleep Quality ◽  
Training Program ◽  
Randomized Clinical Trial ◽  
Thalassemia Major ◽  
Trial Registration ◽  
Control Group ◽  
Positive Thinking ◽  
Experimental Group

Abstract Background Thalassemia have a negative impact on the patients' psychological health and sleep quality. This study aimed to determine the effects of a positive thinking training program on hope and sleep quality of patients with thalassemia major. Methods This randomized clinical trial was conducted on 78 patients with thalassemia major including 36 males (46.2%) and 42 females (53.8%) with a mean age of 25.56 ± 29.6 in Iran. Subjects were randomly assigned into experimental and control groups. Experimental group received 16 h training based on positive thinking materials published by Martin Seligman. Control group received only usual programs. Data were collected at baseline, as well as immediately and one month after the intervention, using Snyder’s Hope Scale and the Pittsburgh Sleep Quality Index. Data analysis was performed using SPSS Software 18.0; statistical tests included the independent T-test, the Chi-square, Mann Whitney, and Friedman test. Significance level was set at 0.05 in this study. Results The experimental group had a significantly higher mean hope score compared to the control group immediately (45.38 ± 7.82 vs. 35.32 ± 5.54, P < 0.001) and one month following intervention (44.67 ± 3.47 vs. 35 ± .54, P < 0.001). Moreover, the mean sleep quality scores of the experimental group was significantly greater than that for control group immediately (5.35 ± 2.02 vs. 7 ± 2.4, P = 0.004) and one month after the intervention (4.23 ± 2.2 vs.7.02 ± 3.03, P < 0.001). Conclusion Since our training program on positive thinking improved hope and quality of sleep in patients with thalassemia major, we recommend the use of such courses as an important step toward promotion of hope and sleep quality among these patients. Trial registration The name of the registry: Iranian Registry of Clinical Trials. Trial Registration Number: IRCT2017010431774N1. URL of the trial registry record: https://en.irct.ir/trial/24923. Registration Date: 07/03/2017.

scholarly journals Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle

2019 ◽  
Vol 17 (1) ◽  
pp. 113 ◽  
Author(s):  
Nahid Norouzi-Gheidari ◽  
Alejandro Hernandez ◽  
Philippe S. Archambault ◽  
Johanne Higgins ◽  
Lise Poissant ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Intervention Group ◽  
Outpatient Rehabilitation ◽  
Control Group ◽  
Stroke Survivors ◽  
Post Intervention ◽  
Serious Adverse Events ◽  
Traditional Therapy ◽  
Post Stroke

(1) Background: Increasing the amount of therapy time has been shown to improve motor function in stroke survivors. However, it is often not possible to increase the amount of therapy time provided in the current one-on-one therapy models. Rehabilitation-based virtual reality exergame systems, such as Jintronix, can be offered to stroke survivors as an adjunct to traditional therapy. The goal of this study was to examine the safety and feasibility of providing additional therapy using an exergame system and assess its preliminary clinical efficacy. (2) Methods: Stroke survivors receiving outpatient rehabilitation services participated in this pilot randomized control trial in which the intervention group received 4 weeks of exergaming sessions in addition to traditional therapy sessions. (3) Results: Nine subjects in the intervention and nine subjects in the control group completed the study. The intervention group had at least two extra sessions per week, with an average duration of 44 min per session and no serious adverse events (falls, dizziness, or pain). The efficacy measures showed statistically meaningful improvements in the activities of daily living measures (i.e., MAL-QOM (motor activity log-quality of movement) and both mobility and physical domains of the SIS (stroke impact scale) with mean difference of 1.0%, 5.5%, and 6.7% between the intervention and control group, respectively) at post-intervention. (4) Conclusion: Using virtual reality exergaming technology as an adjunct to traditional therapy is feasible and safe in post-stroke rehabilitation and may be beneficial to upper extremity functional recovery.

scholarly journals Effect of Health Education via Mobile Application in Promoting Quality of Life Among Asthmatic Schoolchildren in Urban Malaysia During the COVID-19 Era: A Quasi-Experimental Study

2021 ◽  
Author(s):  
Abdulaziz Mansoor Al Raimi ◽  
Mei Chan Chong ◽  
Li Yoong Tang ◽  
Yan Piaw Chua ◽  
Latifa Yahya Al Ajeel
Keyword(s):  
Quality Of Life ◽  
Health Education ◽  
Mobile Application ◽  
Control Group ◽  
Post Intervention ◽  
Face To Face ◽  
Quasi Experimental ◽  
And Control ◽  
Experimental Group

Abstract BACKGROUND: Bronchial asthma among children is a common chronic disease which may have impact on quality of life. Health education is one of the strategy to improve knowledge and quality of life.OBJECTIVE: The study aims to assess the effect of health education via mobile application (app) in promoting quality of life among schoolchildren with asthma in urban Malaysia during the COVID-19 era. METHODS: A quasi-experimental, pre- and post-intervention design was used in this study involving a total of 214 students, randomly assigned into two groups (intervention group and control group). The control group received face-to-face health education while the experimental group received health education via a mobile application.RESULTS: The findings showed that the total score of quality of life (QoL) has improved from a mean total score at pre-intervention (5.31±1.27) to post-intervention (5.66±1.28) for the control group, compared with the experimental group with a mean total score of QoL at pre-intervention (5.01±1.36) and post-intervention (5.85±1.29). A comparison between the experimental and control groups using an independent t-test showed statistically significant differences in their mean QoL scores. The effect of health education via mobile application showed a statistically significant improvement in the mean QoL score from pre- to post-intervention [F (1,288) = 57.46, p = <0.01].CONCLUSION: The use of mobile technology in health education improved QoL as compared to the traditional methods of face-to-face lecture and/or handbooks among schoolchildren with asthma. Thus, educational modules using mobile applications do improve QoL.

scholarly journals Effect of Health Education Via Mobile Application in Promoting Quality of Life Among Asthmatic Schoolchildren in Urban Malaysia: A Quasi-Experimental Study

2021 ◽  
Author(s):  
Abdulaziz Mansoor Al Raimi ◽  
Mei Chan Chong ◽  
Li Yoong Tang ◽  
Yan Piaw Chua ◽  
Latifa Yahya Al Ajeel
Keyword(s):  
Quality Of Life ◽  
Health Education ◽  
Mobile Application ◽  
Control Group ◽  
Post Intervention ◽  
Face To Face ◽  
Quasi Experimental ◽  
And Control ◽  
Experimental Group

Abstract BACKGROUND: Bronchial asthma among children is a common chronic disease which may have impact on quality of life. Health education is one of the strategy to improve knowledge and quality of life.OBJECTIVE: The study aims to assess the effect of health education via mobile application (app) in promoting quality of life among schoolchildren with asthma in urban Malaysia.METHODS: A quasi-experimental, pre- and post-intervention design was used in this study during the period September 2016 until April 2017 involving a total of 214 students, randomly assigned into two groups (intervention group and control group). The control group received face-to-face health education while the experimental group received health education via a mobile application.RESULTS: The findings showed that the total score of quality of life (QoL) has improved from a mean total score at pre-intervention (5.31±1.27) to post-intervention (5.66±1.28) for the control group, compared with the experimental group with a mean total score of QoL at pre-intervention (5.01±1.36) and post-intervention (5.85±1.29). A comparison between the experimental and control groups using an independent t-test showed statistically significant differences in their mean QoL scores. The effect of health education via mobile application showed a statistically significant improvement in the mean QoL score from pre- to post-intervention [F (1,288) = 57.46, p = <0.01].CONCLUSION: The use of mobile technology in health education improved QoL as compared to the traditional methods of face-to-face lecture and/or handbooks among schoolchildren with asthma. Thus, educational modules using mobile applications do improve QoL.

scholarly journals Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke: A pilot randomized controlled trial

2021 ◽  
Author(s):  
Liselot Thijs ◽  
Eline Voets ◽  
Evelien Wiskerke ◽  
Thomas Nauwelaerts ◽  
Yves Arys ◽  
...  
Keyword(s):  
Usual Care ◽  
Balance Training ◽  
Group Versus ◽  
Chronic Stroke ◽  
Control Group ◽  
Post Intervention ◽  
Functional Balance ◽  
Randomized Controlled ◽  
Sitting Balance ◽  
Experimental Group

Abstract Insights in evidence on sitting balance and trunk rehabilitation have not resulted in specific device development. Hence, intensive one-by-one therapist-patient guidance is still required. We developed a novel rehabilitation prototype, specifically aimed at providing sitting balance therapy. In this study, we investigated if technology-supported sitting balance training was feasible and safe in chronic stroke patients and we evaluated whether clinical outcomes improved after a four-week programme when compared with usual care. Methods. In this parallel-group, assessor-blinded, randomized controlled pilot trial, we divided first event chronic stroke participants randomly into two groups. The experimental group received usual care plus additional therapy supported by rehabilitation technology consisting of 12 sessions of 50 minutes of therapy in four weeks. The control group received usual care only. We assessed all participants twice pre-intervention and once post-intervention. Feasibility and safety were descriptively analysed. Between-group analysis evaluated the differences in changes in motor and functional outcomes. Results. In total, 30 participants were recruited and 29 completed the trial (experimental group, n=14; control group, n=15). There were no between-group differences at baseline. Therapy was evaluated feasible by participants and therapist. There were no serious adverse events during sitting balance therapy. Changes in clinical outcomes from pre- to post-intervention demonstrated an increase in the experimental compared to the control group for trunk function; mean (standard deviation [SD]): 7.07 (1.69) versus 0.33 (2.35) points on trunk impairment scale (p<.000), maximum walking speed on 10-meter walk test (0.16 (0.16) m/s in the experimental group versus 0.06 (0.06) m/s in the control group; p=.003), and functional balance measured using Berg balance scale (median [interquartile range] 4.5 (5) points in the experimental group versus 0 (4) points in the control group (p=.014). Conclusions. Technology-supported sitting balance training in persons with chronic stroke is feasible and safe. A four-week, 12-hour programme on top of usual care suggests beneficial effects for trunk function, maximum gait speed and functional balance.Trial Registration: ClinicalTrials.gov identifier: NCT04467554, https://clinicaltrials.gov/ct2/show/NCT04467554, date of Registration: 13 July 2020.

scholarly journals Mindfulness Meditation Effects on Poststroke Spasticity: A Feasibility Study

2019 ◽  
Vol 24 ◽  
pp. 2515690X1985594 ◽  
Author(s):  
Melanie Wathugala ◽  
David Saldana ◽  
Julia M. Juliano ◽  
Jennifer Chan ◽  
Sook-Lei Liew
Keyword(s):  
Quality Of Life ◽  
Feasibility Study ◽  
Repeated Measures ◽  
Mindfulness Meditation ◽  
Chronic Stroke ◽  
Future Research ◽  
Control Group ◽  
Stroke Survivors ◽  
Repeated Measures Design

This study examined the feasibility of an adapted 2-week mindfulness meditation protocol for chronic stroke survivors. In addition, preliminary effects of this adapted intervention on spasticity and quality of life in individuals after stroke were explored. Ten chronic stroke survivors with spasticity listened to 2 weeks of short mindfulness meditation recordings, adapted from Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction course, in a pre/post repeated measures design. Measures of spasticity, quality of life, mindfulness, and anxiety, along with qualitative data from participants’ daily journals, were assessed. On average, participants reported meditating 12.5 days of the full 15 days (mean 12.5 days, SD 0.94, range 8-15 days). Seven of the 10 participants wrote comments in their journals. In addition, there were no adverse effects due to the intervention. Exploratory preliminary analyses also showed statistically significant improvements in spasticity in both the elbow ( P = .032) and wrist ( P = .023) after 2 weeks of meditation, along with improvements in quality of life measures for Energy ( P = .013), Personality ( P = .026), and Work/Productivity ( P = .032). This feasibility study suggests that individuals with spasticity following stroke are able to adhere to a 2-week home-based mindfulness meditation program. In addition, preliminary results also suggest that this adapted, short mindfulness meditation program might be a promising approach for individuals with spasticity following stroke. Future research should expand on these preliminary findings with a larger sample size and control group.

scholarly journals Relief Alternatives during Resuscitation: Instructions to Teach Bystanders. A Randomized Control Trial

2020 ◽  
Vol 17 (15) ◽  
pp. 5495
Author(s):  
María José Pujalte-Jesús ◽  
César Leal-Costa ◽  
María Ruzafa-Martínez ◽  
Antonio Jesús Ramos-Morcillo ◽  
José Luis Díaz Agea
Keyword(s):  
Chest Compression ◽  
Emergency Services ◽  
Control Group ◽  
Post Intervention ◽  
Specific Objective ◽  
Randomized Control ◽  
Random Groups ◽  
Experimental Group ◽  
Simulated Scenario

To analyze the quality of resuscitation (CPR) performed by individuals without training after receiving a set of instructions (structured and unstructured/intuitive) from an expert in a simulated context, the specific objective was to design a simple and structured CPR learning method on-site. An experimental study was designed, consisting of two random groups with a post-intervention measurement in which the experimental group (EG) received standardized instructions, and the control group (CG) received intuitive or non-standardized instructions, in a public area simulated scenario. Statistically significant differences were found (p < 0.0001) between the EG and the CG for variables: time needed to give orders, pauses between chest compressions and ventilations, depth, overall score, chest compression score, and chest recoil. The average depth of the EG was 51.1 mm (SD 7.94) and 42.2 mm (SD 12.04) for the CG. The chest recoil median was 86.32% (IQR 62.36, 98.87) for the EG, and 58.3% (IQR 27.46, 84.33) in the CG. The use of a sequence of simple, short and specific orders, together with observation-based learning makes possible the execution of chest compression maneuvers that are very similar to those performed by rescuers, and allows the teaching of the basic notions of ventilation. The structured order method was shown to be an on-site learning opportunity when faced with the need to maintain high-quality CPR in the presence of an expert resuscitator until the arrival of emergency services.

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