scholarly journals A Comparison of Overlapping Effects of Therapeutic Interventions to Improve Upper Limb Spasticity and Function in Stroke Patients

2020 ◽  
Vol 12 (16) ◽  
pp. 09-17
Author(s):  
Jung-Ho Lee
Keyword(s):  
Upper Limb ◽  
Therapeutic Interventions ◽  
Stroke Patients ◽  
Limb Spasticity ◽  
And Function

scholarly journals Motor‐imagery ability and function of hemiplegic upper limb in stroke patients

2019 ◽  
Vol 6 (3) ◽  
pp. 596-604 ◽  
Author(s):  
Shu Morioka ◽  
Michihiro Osumi ◽  
Yuki Nishi ◽  
Tomoya Ishigaki ◽  
Rintaro Ishibashi ◽  
...  
Keyword(s):  
Motor Imagery ◽  
Upper Limb ◽  
Imagery Ability ◽  
Stroke Patients ◽  
And Function

scholarly journals The Influence of Primary Motor Cortex Inhibition on Upper Limb Impairment and Function in Chronic Stroke: A Multimodal Study

2019 ◽  
Vol 33 (2) ◽  
pp. 130-140 ◽  
Author(s):  
Ronan A. Mooney ◽  
Suzanne J. Ackerley ◽  
Deshan K. Rajeswaran ◽  
John Cirillo ◽  
P. Alan Barber ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Motor Impairment ◽  
Intracortical Inhibition ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Gaba Concentration ◽  
Chronic Stage ◽  
And Function

Background. Stroke is a leading cause of adult disability owing largely to motor impairment and loss of function. After stroke, there may be abnormalities in γ-aminobutyric acid (GABA)-mediated inhibitory function within primary motor cortex (M1), which may have implications for residual motor impairment and the potential for functional improvements at the chronic stage. Objective. To quantify GABA neurotransmission and concentration within ipsilesional and contralesional M1 and determine if they relate to upper limb impairment and function at the chronic stage of stroke. Methods. Twelve chronic stroke patients and 16 age-similar controls were recruited for the study. Upper limb impairment and function were assessed with the Fugl-Meyer Upper Extremity Scale and Action Research Arm Test. Threshold tracking paired-pulse transcranial magnetic stimulation protocols were used to examine short- and long-interval intracortical inhibition and late cortical disinhibition. Magnetic resonance spectroscopy was used to evaluate GABA concentration. Results. Short-interval intracortical inhibition was similar between patients and controls ( P = .10). Long-interval intracortical inhibition was greater in ipsilesional M1 compared with controls ( P < .001). Patients who did not exhibit late cortical disinhibition in ipsilesional M1 were those with greater upper limb impairment and worse function ( P = .002 and P = .017). GABA concentration was lower within ipsilesional ( P = .009) and contralesional ( P = .021) M1 compared with controls, resulting in an elevated excitation-inhibition ratio for patients. Conclusion. These findings indicate that ipsilesional and contralesional M1 GABAergic inhibition are altered in this small cohort of chronic stroke patients. Further study is warranted to determine how M1 inhibitory networks might be targeted to improve motor function.

scholarly journals Use of botulinum toxin in stroke patients with severe upper limb spasticity.

1996 ◽  
Vol 61 (1) ◽  
pp. 30-35 ◽  
Author(s):  
B B Bhakta ◽  
J A Cozens ◽  
J M Bamford ◽  
M A Chamberlain
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Stroke Patients ◽  
Limb Spasticity

scholarly journals A cutlery set for stroke

2021 ◽  
Author(s):  
◽  
Lin Chen
Keyword(s):  
Assistive Technology ◽  
Upper Limb ◽  
Stroke Patient ◽  
The United States ◽  
Stroke Severity ◽  
Muscle Control ◽  
Stroke Patients ◽  
Muscle Contracture ◽  
And Function

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997).  After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function.  AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life.  The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians.  Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design.  The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant.  The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>

scholarly journals A cutlery set for stroke

2021 ◽  
Author(s):  
◽  
Lin Chen
Keyword(s):  
Assistive Technology ◽  
Upper Limb ◽  
Stroke Patient ◽  
The United States ◽  
Stroke Severity ◽  
Muscle Control ◽  
Stroke Patients ◽  
Muscle Contracture ◽  
And Function

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997).  After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function.  AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life.  The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians.  Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design.  The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant.  The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>

Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients

2019 ◽  
Vol 26 (7) ◽  
pp. 1-9
Author(s):  
Luciana Protásio de Melo ◽  
Valton da Silva Costa ◽  
Júlio César Cunha da Silveira ◽  
Tatiana Catarina Albuquerque Clementino
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Functional Independence ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Limb Spasticity ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
The Impact

Background/Aims Strokes lead to different levels of disability. During the chronic stage, hemiparesis, spasticity and motor deficits may cause loss of functional independence. Mirror therapy aims to reduce deficits and increase functional recovery of the impaired upper limb. This study aimed to evaluate the effects of mirror therapy on upper limb spasticity and motor function, as well as its impact on functional independence in chronic hemiparetic patients. Methods In this quasi-experimental study, eight chronic hemiparetic patients (age 55.5 ± 10.8 years) were assessed to determine their degree of spasticity (Modified Ashworth Scale), level of upper limb motor function (Fugl-Meyer Assessment) and functionality (Functional Independence Measure). All participants received 12 sessions of mirror therapy delivered three times per week, over a period of 4 weeks. Participants were re-evaluated post-intervention and these results were compared to their pre-intervention scores to determine the impact of mirror therapy. Results A decrease in spasticity was observed, with significant improvements in shoulder extensors (P=0.033) and a significant increase in motor function (P=0.002). The therapeutic protocol adopted did not have a significant effect on functional independence (P=0.105). Conclusions Mirror therapy led to improvements in upper limb spasticity and motor function in chronic hemiparetic stroke patients. No effects on functional independence were observed. Further research with a larger number of patients is needed to provide more robust evidence of the benefits of mirror therapy in chronic hemiparetic stroke patients.

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

2005 ◽  
Vol 19 (1) ◽  
pp. 27-32 ◽  
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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