scholarly journals Modified Constraint-Induced Therapy in Patients With Chronic Stroke Exhibiting Minimal Movement Ability in the Affected Arm

2007 ◽  
Vol 87 (7) ◽  
pp. 872-878 ◽  
Author(s):  
Stephen J Page ◽  
Peter Levine
Keyword(s):  
Case Series ◽  
Chronic Stroke ◽  
Fine Motor ◽  
Fine Motor Skill ◽  
Movement Ability ◽  
Quality Of Movement ◽  
And Function ◽  
Therapy Sessions ◽  
Mean Time

Background and Purpose The purpose of this study was to determine the efficacy of a reimbursable, outpatient modified constraint-induced therapy (mCIT) protocol administered to subjects with chronic stroke who initially exhibited minimal movement ability in their affected wrists and fingers. Subjects The subjects were 4 individuals who had experienced a stroke more than 1 year prior to study entry (mean age [±SD]=60.25±1.98 years, mean time since stroke=37.5±23.2 months). Method A multiple-baseline, preintervention-postintervention, single-blinded case series design was used. The intervention consisted of structured, ½-hour therapy sessions emphasizing affected arm use in valued activities, occurring 3 times per week for 10 weeks. Subjects’ less affected arms also were restrained 5 days per week for 5 hours per day during the same 10-week period. The main outcome measures were the Action Research Arm Test (ARAT), the Motor Activity Log (MAL), and the Fugl-Meyer Assessment of Motor Recovery (FM). Results The subjects exhibited improvements in use of the more affected arm (+1.9, +1.8, +1.7, and +2.3 for subjects 1 through 4, respectively) and in quality of movement (+1.5, +2.1, +1.63, and +1.9 for subjects 1 through 4, respectively), as measured by the MAL. They also exhibited reduced impairment, as measured by the FM (+5.0, +6.5, +5.5, and +5.0 for subjects 1 through 4, respectively), and increased fine motor skill movement, as measured by the ARAT (+7.5, +7.0, +7.0, and +5.5 for subjects 1 through 4, respectively). Discussion and Conclusion The findings demonstrated that mCIT participation was efficacious because it led to increased use of the affected arm and of function and to increased ability to perform valued activities. The subjects reported some new ability to perform some valued activities. These outcomes are significant because few therapies are believed to effectively increase use of the affected arm and function in this population.

scholarly journals Modified Constraint-Induced Therapy in Chronic Stroke: Results of a Single-Blinded Randomized Controlled Trial

2008 ◽  
Vol 88 (3) ◽  
pp. 333-340 ◽  
Author(s):  
Stephen J Page ◽  
Peter Levine ◽  
Anthony Leonard ◽  
Jerzy P Szaflarski ◽  
Brett M Kissela
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Exercise Program ◽  
Chronic Stroke ◽  
Randomized Controlled ◽  
Control Regimen ◽  
Quality Of Movement ◽  
And Function ◽  
Therapy Sessions

Background and Purpose This single-blinded randomized controlled trial compared the efficacy of a reimbursable, outpatient, modified constraint-induced therapy (mCIT) protocol (half-hour therapy sessions occurring 3 days per week in which subjects used the more affected arm combined with less affected arm restriction 5 days per week for 5 hours; both of these regimens were administered during a 10-week period) with that of a time-matched exercise program for the more affected arm or a no-treatment control regimen. Subjects Thirty-five subjects with chronic stroke participated in the study. Methods The Action Research Arm Test (ARAT), Fugl-Meyer Assessment of Motor Recovery After Stroke (FM), and Motor Activity Log (MAL) were administered to the subjects. Results After intervention, significant differences were observed on the ARAT and MAL Amount of Use and Quality of Movement scales, all in favor of the mCIT group. Discussion and Conclusion The data affirm previous findings suggesting that this reimbursable, outpatient protocol increases more affected arm use and function. Magnitude of changes was consistent with those reported in more intense protocols, such as constraint-induced therapy.

Effects of anodal tDCS and occupational therapy on fine motor skill deficits in patients with chronic stroke

2016 ◽  
Vol 34 (6) ◽  
pp. 935-945 ◽  
Author(s):  
Nela V. Ilić ◽  
Emilija Dubljanin-Raspopović ◽  
Una Nedeljković ◽  
Sanja Tomanović-Vujadinović ◽  
Sladjan D. Milanović ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Motor Skill ◽  
Chronic Stroke ◽  
Fine Motor ◽  
Anodal Tdcs ◽  
Fine Motor Skill ◽  
Skill Deficits

scholarly journals Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affecter Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability. Case Series

2020 ◽  
Author(s):  
Rocío Palomo-Carrión ◽  
Rita-Pilar Romero-Galisteo ◽  
Elena Piñero-Pinto ◽  
Purificación López-Muñoz ◽  
Helena Romay-Barrero ◽  
...  
Keyword(s):  
Upper Limb ◽  
Case Series ◽  
Movement Therapy ◽  
Low Intensity ◽  
Constraint Induced Movement Therapy ◽  
Case Series Study ◽  
Quality Of Movement ◽  
Prospective Case Series ◽  
Quest Scale

Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified constraint-induced movement therapy(mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were: quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp-release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the QUEST scale, the SHUEE Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of 8 children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p<0.05). The greatest increase occurred in spontaneous use from assessment 1-4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb obtained a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 hours) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.

scholarly journals Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

2018 ◽  
Vol 44 (6) ◽  
pp. E15 ◽  
Author(s):  
Malte Mohme ◽  
Friederike S. Fritzsche ◽  
Klaus C. Mende ◽  
Jakob Matschke ◽  
Ulrike Löbel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Course ◽  
Case Series ◽  
Diffuse Astrocytoma ◽  
The Mean ◽  
Mean Time ◽  
Tectal Glioma ◽  
Astrocytoma Grade

OBJECTIVETectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical course is highly variable and that there is a potential for a progressive biology.METHODSClinical data analysis of 23 cases of tectal glioma (involving 9 children and 14 adults) was performed retrospectively. Radiographic data were analyzed longitudinally and MR images were evaluated for tumor volume, contrast enhancement, and growth progression. Quality of life was assessed using the EORTC BN20 and C30 questionnaires during follow-up in a subgroup of patients.RESULTSThe patients’ mean age at diagnosis was 29.2 years. The main presenting symptom at diagnosis was hydrocephalus (80%). Six patients were treated by primary tumor resection (26.1%), 3 patients underwent biopsy followed by resection (13.1%), and 3 patients underwent biopsy only (13.1%). For additional treatment of hydrocephalus, 14 patients (60.9%) received shunts and/or endoscopic third ventriculostomy. Radiographic tumor progression was observed in 47.9% of the 23 cases. The mean time between diagnosis and growth progression was 51.5 months, and the mean time to contrast enhancement was 69.7 months. Histopathological analysis was obtained in 12 cases (52.2%), resulting in 5 cases of high-grade glioma (3 cases of glioblastoma multiforme [GBM], grade IV, and 2 of anaplastic astrocytoma, grade III), 5 cases of pilocytic astrocytoma, 1 diffuse astrocytoma, and 1 ganglioglioma. Malignant progression was observed in 2 cases, with 1 case progressing from a diffuse astrocytoma (grade II) to a GBM (grade IV) within a period of 13 years. Quality-of-life measurements demonstrated distinct functional deficits compared to a healthy sample as well as glioma control cohorts.CONCLUSIONSAnalysis of this case series shows that a major subpopulation of tectal gliomas show progression and malignant transformation in children as well as in adolescents. These tumors therefore cannot be considered inert lesions and require histological confirmation and close follow-up. Quality-of-life questionnaires show that tectal glioma patients might benefit from special psychological support in emotional, social, and cognitive functionality.

Hindfoot endoscopic release of the posterior ankle capsuloligamentous structures improves ankle dorsiflexion range, function and pain in patients with painful limitation of ankle dorsiflexion

2020 ◽  
Vol 5 (1) ◽  
pp. 21-25
Author(s):  
Benjamin Hickey ◽  
Miquel Dalmau-Pastor ◽  
Jón Karlsson ◽  
James Calder
Keyword(s):  
Case Series ◽  
Ankle Dorsiflexion ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Endoscopic Release ◽  
Range Function ◽  
Age At Surgery ◽  
Outcome Scores ◽  
And Function

ObjectiveTo evaluate the effect of arthroscopic release of the posterior capsuloligamentous structures on ankle dorsiflexion and function in patients with painful limitation of ankle dorsiflexion.MethodsA prospective consecutive case series of 13 adult patients with painful limitation of ankle dorsiflexion were included. None had clinically relevant gastrocnemius, soleus or Achilles contracture. Patients with anterior bony impingement or ankle degeneration on CT scan were excluded. All patients underwent combined anterior and posterior ankle arthroscopies with resection of posterior capsuloligamentous structures and the posterior fibulotalocalcaneal ligament. Ankle range of motion was assessed 2 years postoperatively. Foot and Ankle Outcome Scores (FAOS) were used to assess functional outcome.ResultsThe median patient age at surgery was 26 years (range 19–44). At 2 years postsurgery, the ankle dorsiflexion range had increased by 15 degrees (range 0–25, p<0.0001). FAOSs completed at a median of 44 months postsurgery (range 26–72) significantly improved. Median improvements were 19 points for pain (range 6–67, p=0.0004), 14 points for symptoms (range 0–36, p=0.0005), 15 points for activities of daily living (range 6–35, p<0.0001), 45 points for sport (range 20–55, p<0.0001) and 50 points for quality of life (range 13–62, p<0.0001).ConclusionsHindfoot endoscopic release of the posterior ankle structures, including the posterior fibulotalocalcaneal ligament, is an effective technique for improving ankle dorsiflexion range in patients with painful limitation of ankle dorsiflexion.Level of evidenceIV.

scholarly journals Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke

2018 ◽  
Vol 32 (4-5) ◽  
pp. 295-308 ◽  
Author(s):  
Manuela Hamoudi ◽  
Heidi M. Schambra ◽  
Brita Fritsch ◽  
Annika Schoechlin-Marx ◽  
Cornelius Weiller ◽  
...  
Keyword(s):  
Motor Function ◽  
Direct Current ◽  
Motor Skill ◽  
Transcranial Direct Current Stimulation ◽  
Chronic Stroke ◽  
Skill Learning ◽  
Fine Motor ◽  
Motor Skill Learning ◽  
Fine Motor Skill ◽  
Direct Current Stimulation

Background. Motor training alone or combined with transcranial direct current stimulation (tDCS) positioned over the motor cortex (M1) improves motor function in chronic stroke. Currently, understanding of how tDCS influences the process of motor skill learning after stroke is lacking. Objective. To assess the effects of tDCS on the stages of motor skill learning and on generalization to untrained motor function. Methods. In this randomized, sham-controlled, blinded study of 56 mildly impaired chronic stroke patients, tDCS (anode over the ipsilesional M1 and cathode on the contralesional forehead) was applied during 5 days of training on an unfamiliar, challenging fine motor skill task (sequential visual isometric pinch force task). We assessed online and offline learning during the training period and retention over the following 4 months. We additionally assessed the generalization to untrained tasks. Results. With training alone (sham tDCS group), patients acquired a novel motor skill. This skill improved online, remained stable during the offline periods and was largely retained at follow-up. When tDCS was added to training (real tDCS group), motor skill significantly increased relative to sham, mostly in the online stage. Long-term retention was not affected by tDCS. Training effects generalized to untrained tasks, but those performance gains were not enhanced further by tDCS. Conclusions. Training of an unfamiliar skill task represents a strategy to improve fine motor function in chronic stroke. tDCS augments motor skill learning, but its additive effect is restricted to the trained skill.

scholarly journals The Emergence of Stereotyped Kinematic Synergies when Mice Reach to Grasp Following Stroke

2021 ◽  
pp. 154596832110581
Author(s):  
Gustavo Balbinot ◽  
Sebastien Denize ◽  
Diane C. Lagace
Keyword(s):  
Clinical Studies ◽  
Kinematic Analysis ◽  
Recovery Of Function ◽  
Fine Motor ◽  
Reach To Grasp ◽  
Functional Deficits ◽  
Kinematic Synergies ◽  
Quality Of Movement ◽  
Preclinical And Clinical Studies

Reaching tasks are commonly used in preclinical and clinical studies to assess the acquisition of fine motor skills and recovery of function following stroke. These tasks are often used to assess functional deficits in the absence of quantifying the quality of movement which requires kinematic analysis. To meet this need, this study uses a kinematic analysis in mice performing the Montoya staircase task at 5 and 14 days following a cortical photothrombosis-induced stroke. Following stroke, the mice had reaching impairments associated with sustained deficits including longer, unsmooth, and less individuated paw trajectories. Two weeks after stroke we also detected the emergence of abnormal elbow and shoulder angles, flexion/extensions, and stereotyped kinematic synergies. These data suggest that proximal and distal segments acting in concert is paramount during post-stroke reaching and encourage further analysis of synergies within the translational pipeline of preclinical to clinical studies.

scholarly journals Quality of Life after Liver Transplantation

1990 ◽  
Vol 4 (2) ◽  
pp. 49-52 ◽  
Author(s):  
David Grant ◽  
David Evans ◽  
Margaret Hearn ◽  
John Duff ◽  
Cameron Ghent ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Personal Growth ◽  
Family Relations ◽  
Well Being ◽  
And Function ◽  
Karnofsky Performance Index ◽  
Mean Time

The results of liver transplantation are now well established in terms of graft and patient survival, but there is surprisingly little data on the quality of life attained. The authors mailed questionnaires to 32 consecutive adult liver recipients to assess their quality of life. Thirty-one patients (14 males, 17 females) with a mean age of 37 years (range 16 to 55), responded (97%). The mean time since transplantation was 19 months (range three to 50). Eighty percent of the respondents functioned at normal or near normal levels as measured by the Karnofsky Performance Index. Sixty-five per cent (20 patients) indicated they were currently able to live and function as they did before they became ill with liver disease. The respondents' scores were similar to normative scores on all of the following measures: life satisfaction, well being, and general affect (Campbell); and material well being, personal growth, marital relations, family relations and friendships (Evans). It is concluded that liver transplantation restores physical, mental and social well being in most patients with endstage liver disease.

scholarly journals Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series

Children ◽  
2020 ◽  
Vol 7 (9) ◽  
pp. 127
Author(s):  
Rocío Palomo-Carrión ◽  
Rita-Pilar Romero-Galisteo ◽  
Elena Pinero-Pinto ◽  
Purificación López-Muñoz ◽  
Helena Romay-Barrero ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Case Series ◽  
Movement Therapy ◽  
Low Intensity ◽  
Constraint Induced Movement Therapy ◽  
Case Series Study ◽  
Quality Of Movement ◽  
Pre Treatment

Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified Constraint-Induced Movement Therapy (mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp–release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the quality of upper extremity test (QUEST) scale, the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of eight children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p < 0.05) between the pre-treatment and post–treatment results (Week 0–Week 5), except for upper limb dressing, putting on splints and buttoning up. In the first week, the changes were statistically significant, except for protective extension, grasp strength, grasp–release and all functional variables (level of functionality and participation of the patient’s upper limbs) in the SHUEE Evaluation (p > 0.05). The greatest increase occurred in spontaneous use from Assessment 1 to Assessment 4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb exhibited a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 h) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.

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