The effect of clinical application of transcranial direct current stimulation combined with non-immersive virtual reality rehabilitation in stroke patients

Technology and Health Care ◽

10.3233/thc-212991 ◽

2021 ◽

pp. 1-11

Author(s):

SiA Lee ◽

HyunGyu Cha

Keyword(s):

Executive Function ◽

Upper Limb ◽

Control Group ◽

Stroke Patients ◽

Limb Function ◽

Upper Limb Function ◽

Intervention Method ◽

Post Test ◽

Vr Training ◽

Experimental Group

BACKGROUND: The ability to manipulate the upper limbs and fingers of stroke patients is very important for independent daily life. Among the latest approaches for upper limb rehabilitation training, transcranial direct current stimulation (tDCS) is a non-invasive stimulation method that stimulates the cranial nerves by attaching electrodes to the scalp. In addition, virtual reality (VR) is an intervention method that provides an environment similar to reality and can help restore function by performing body movements as if playing a game. In addition, VR is an intervention method that provides an environment similar to reality and helps to recover functions by performing body movements as if playing a game. OBJECTIVE: This study was conducted to investigate the effect of anodal tDCS applied to the ipsilateral primary motor cortex (M1) during VR training on the upper limb function, cognition, and executive function of stroke patients. METHODS: After 20 patients were randomly assigned to the experimental group and the control group, the experimental group received tDCS and VR, and the control group received sham tDCS and VR for 20 minutes a day, 5 days a week, for a total of 4 weeks. Participants were evaluated for upper limb function using Box and Block Test (BBT) and Jebsen-Taylor Hand Function Test (JTHFT), and cognitive and executive function using the Stroop Test (ST) and Trail Making Test (TMT). RESULTS: In the experimental group, significant differences were found in the pre- and post-test for the all variance (p< 0.05). Control group is significant differences were found in the pre- and post-test for BBT, ST, TMT (p< 0.05). There were significant differences between the two groups in the post test of BBT and ST (p< 0.05). CONCLUSION: The results of this study suggest that anodal tDCS applied to the ipsilateral M1 during VR training is effective for upper limb function, cognitive function, and executive function in stroke patients.

Download Full-text

The effect of virtual reality on motor anticipation and hand function in patients with subacute stroke: A randomised trial on movement-related potential.

10.21203/rs.2.21922/v2 ◽

2020 ◽

Author(s):

Ling Chen ◽

Yi Chen ◽

Wai Leung Ambrose Lo

Keyword(s):

Virtual Reality ◽

Reaction Time ◽

Upper Limb ◽

Cortical Excitability ◽

Control Group ◽

Post Intervention ◽

Limb Function ◽

Upper Limb Function ◽

Subacute Stroke ◽

Vr Training

Abstract Background: Impaired cognitive ability to anticipate the required control may affect functional recovery. The cortical excitability of task related motor anticipation for upper limb movement induced by virtual reality (VR) training is unknown. Aims: To investigate the changes of motor anticipation, cortical excitability and upper limb function induced by VR training in subacute stroke survivors. Methods: Upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 6 months were recruited. Participants were randomly allocated to conventional therapy or VR intervention. Electroencephalogram (EEG) and electromyography (EMG) were simultaneously recorded during palmar grasp motion. Outcome measures of contingent negative variation (CNV) latency, mean peak amplitude, electromyography (EMG) reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA) and the Action Research Arm Test (ARAT) were recorded pre and post intervention. The EEG and EMG differences between the two groups were assessed by mixed model ANOVA (p=0.05). The differences in UL-FMA and ARAT were assessed Wilcoxon signed-rank test (p=0.05). Results: The reduction in EMG reaction time difference, CNV latency and mean peak amplitude were significantly lower in the VR group than the control group when executing movement with the paretic hand. ARAT and UL-FMA scores were significantly higher in the VR group than the control group post intervention. Conclusions: The findings indicated a reduction in brain computational demand during palmar grasp task. Improvements in clinical function in the VR group suggested that VR intervention may be more beneficial in improving upper limb function patients with subacute stroke. Improvement in upper limb function may be related to improvement of the neural anticipatory process. Trial registration: Chinese Clinical Trial Registry (Registration No.: ChiCTR-IOC-15006064). Registered on 11 May 2015. Retrospectively registered. http://www.chictr.org.cn/searchprojen.aspx

Download Full-text

Determining the Effects of a Horticultural Therapy Program for Improving the Upper Limb Function and Balance Ability of Stroke Patients

HortScience ◽

10.21273/hortsci12639-17 ◽

2018 ◽

Vol 53 (1) ◽

pp. 110-119 ◽

Cited By ~ 1

Author(s):

A-Young Lee ◽

Sin-Ae Park ◽

Hye-Gyeong Park ◽

Ki-Cheol Son

Keyword(s):

Activities Of Daily Living ◽

Upper Limb ◽

Daily Living ◽

Control Group ◽

Stroke Patients ◽

Horticultural Therapy ◽

Limb Function ◽

Rehabilitation Hospital ◽

Upper Limb Function ◽

Task Oriented

The objective of this study was to assess the physical and psychological effects of an 18-session horticultural therapy (HT) program based on task-oriented training in stroke patients and investigate patient satisfaction. The HT program consisted of horticultural activities including the motions such as reaching–grasping, squatting, stepping, and stooping. A total of 31 stroke inpatients (16 males, 15 females) at B rehabilitation hospital in Seongnam, South Korea, participated in this study. Fourteen stroke patients participated in a thrice weekly HT program (6 weeks, ≈60 minutes per session) between Aug. and Sept. 2016, whereas another 17 stoke patients comprised the control group. At the completion of the 18-session HT program, upper limb function [manual function test (MFT)], grip strength (hydraulic hand dynamometer), pinch force (hydraulic pinch gauge), fine motor skills (9-hole pegboard), balance [Berg Balance Scale (BBS)], and activities of daily living (Modified Barthel Index) were evaluated in both groups. In addition, depression [The Korean version of the short form of Geriatric Depression Scales (SGDS-K)], rehabilitation stress (Rehabilitation Stress Scales), rehabilitation motivation (Rehabilitation Motivation Scales), and fall efficacy (The Korean version of the Falls Efficacy Scale) were evaluated. Stroke patients in the HT group showed significantly improved upper limb function, hand force, balance, fall efficacy, activities of daily living, and decreased depression (P < 0.05). By contrast, no significant change was noted in the control group. In addition, 85.7% of the stroke patients in the HT group reported being very satisfied or satisfied with the HT program. In conclusion, the HT program based on task-oriented training improved the patients’ physical and psychological function after stroke rehabilitation. These study results suggest that implementing an HT program in a rehabilitation hospital will effectively contribute to functional recovery after stroke.

Download Full-text

Effect of Scapular Stabilization Exercise during Standing on Upper Limb Function and Gait Ability of Stroke Patients

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_464_16 ◽

2017 ◽

Vol 08 (04) ◽

pp. 540-544 ◽

Cited By ~ 2

Author(s):

Kim JO ◽

Lee BH ◽

Keyword(s):

Upper Limb ◽

Repeated Measures ◽

Hand Function ◽

Control Group ◽

Study Group ◽

Stroke Patients ◽

Limb Function ◽

Stabilization Exercise ◽

Upper Limb Function ◽

Paretic Side

ABSTRACT Background: The purpose of this study was to determine the effect of scapular stabilization exercise during standing on a paretic side on upper limb function and gait ability of stroke patients. Methods: This study was a hospital-based, randomized controlled trial with a blinded assessor. A total of 17 patients with hemiplegic diagnosis after stroke were divided into two groups (9 patients in a study group and 8 patients in a control group). The study group received physical therapy and scapular stabilization exercise on a paretic side. Participants were subjected to initial evaluation before the treatment. Subjects were subsequently re-evaluated 4 and 8 weeks later to compare the changes. Measurements of hand function and gait ability were performed. Results: Based on multivariate analysis of variance for repeated-measures, there was a significant time effect for Timed Up and Go test (TUG) (F =13.816, P =0.000), Functional Gait Assessment (FGA) (F =18.613, P =0.000), and manual function test (MFT) (F =16.777, P =0.000). The group × time interaction effect was also significant for FGA (F =4.966, P =0.024) and MFT (F =6.946, P =0.003), but not for TUG test (F =3.343, P =0.069). Conclusion: Results of the present study indicated that scapular stabilization exercise during standing on a paretic side for 8 weeks had an effect on hand function and gait ability of hemiplegic patients after stroke. Further studies are needed to find the most proper exercise for stroke patients who have gait disability and upper limb dysfunction.

Download Full-text

Virtual reality on motor anticipation and hand function in patients with subacute stroke : A study on movement-related potential.

10.21203/rs.2.21922/v1 ◽

2020 ◽

Author(s):

Ling Chen ◽

Yi Chen ◽

Wai Leung Ambrose Lo

Keyword(s):

Virtual Reality ◽

Reaction Time ◽

Upper Limb ◽

Cortical Excitability ◽

Control Group ◽

Post Intervention ◽

Limb Function ◽

Upper Limb Function ◽

Subacute Stroke ◽

Vr Training

Abstract Background: Impaired cognitive ability to anticipate the required control may affect functional recovery. The cortical excitability of task related motor anticipation for upper limb movement induced by virtual reality (VR) training is unknown. Aims: To investigate the changes of motor anticipation, cortical excitability and upper limb function induced by VR training in subacute stroke survivors.Methods: Upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 6 months were recruited. Participants were randomly allocated to conventional therapy or VR intervention. Electroencephalogram (EEG) and electromyography (EMG) were simultaneously recorded during parlmar grasp motion. Outcome measures of contingent negative variation (CNV) latency, mean peak amplitude, electromyography (EMG) reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA) and the Action Research Arm Test (ARAT) were recorded pre and post intervention. The EEG and EMG differences between the two groups were assessed by mixed model ANOVA (p=0.05). The differences in UL-FMA and ARAT were assessed Wilcoxon signed-rank test (p=0.05). Results: The reduction in EMG reaction time difference, CNV latency and mean peak amplitude were significantly lower in the VR group than the control group when executing movement with the paretic hand. ARAT and UL-FMA scores were significantly higher in the VR group than the control group post intervention. Conclusions: The findings indicated a reduction in brain computational demand during palmar grasp task. Improvements in clinical function in the VR group suggested that VR intervention may be more beneficial in improving upper limb function patients with subacute stroke. Improvement in upper limb function may be related to improvement of the neural anticipatory process.

Download Full-text

Effects of virtual reality training on upper limb function, balance, and walking ability in stroke patients: a systematic review and meta-meta analysis (Preprint)

10.2196/preprints.31051 ◽

2021 ◽

Author(s):

Jinlong Wu ◽

Aihua Zeng ◽

Ziyan Chen ◽

Ye Wei ◽

Kunlun Huang ◽

...

Keyword(s):

Virtual Reality ◽

Upper Limb ◽

Meta Analysis ◽

Walking Ability ◽

Stroke Patients ◽

High Quality ◽

Limb Function ◽

Upper Limb Function ◽

Vr Training ◽

The Impact

BACKGROUND Virtual reality (VR) training is a promising intervention strategy, which has been utilized in healthcare fields like stroke rehabilitation and psychotherapy. The current study suggests that, VR training is effective in improving the locomotor ability of individuals with stroke patients. OBJECTIVE This is the first meta-meta-analysis of the effects of virtual reality on motor function in stroke patients. This study aimed to systematically summarize and quantify the present meta-analyses results of VR training, and produce high-quality meta-meta-analysis results to obtain a more accurate prediction. METHODS We searched four online databases (Web of Science, Scopus, PubMed, and Chinese National Knowledge Infrastructure) for the meta-analysis studies. After accounting for the overlap, ten studies (almost 550 stroke patients) were obtained. Based on the meta-meta-analysis of these patients, this study quantified the impact of VR training on stroke patients’ motor performance, mainly including upper limb function, balance, and walking ability. We combined the effects under the random effect model and pooled the estimates as standardized mean differences (SMD). RESULTS The results of the meta-meta analysis showed that VR intervention effectively improved the upper limb function (SMD= 4.606, 95% confidence interval (Cl): 2.733-6.479, P< 0.05) and balance (SMD=2.101, 95%Cl：0.202-4.000, P< 0.05) of stroke patients. However, the results showed considerable heterogeneity, and thus, may need to be treated with caution. Due to the limited research, the meta-meta-analysis of walking ability was not performed. CONCLUSIONS These findings represent a comprehensive body of high-quality evidence that, VR interventions were more effective at improving the upper limb function and balance of stroke patients.

Download Full-text

A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF OCCUPATIONAL THERAPY INTERVENTIONS USING PATIENT-CENTERED ROBOT-ASSISTED REHABILITATION FOR FUNCTIONAL IMPROVEMENT IN SUBACUTE STROKE PATIENTS

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519421400406 ◽

2021 ◽

pp. 2140040

Author(s):

DAESEOK YOON ◽

SEUNGBOK LEE ◽

SANG-HYUN CHO ◽

HAEYEAN PARK ◽

JONGBAE KIM

Keyword(s):

Upper Limb ◽

Controlled Trial ◽

Stroke Patients ◽

Robot Assisted ◽

Patient Centered ◽

Limb Function ◽

Randomized Controlled ◽

Upper Limb Function ◽

Experimental Group ◽

Adl Performance

The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.

Download Full-text

Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana, India

International Journal of Biomedical Investigation ◽

10.31531/2581-4745.1000137 ◽

2021 ◽

Vol 4 (2) ◽

pp. 1-6

Author(s):

Keyword(s):

Upper Limb ◽

Test Scores ◽

Radical Mastectomy ◽

Research Approach ◽

Modified Radical Mastectomy ◽

Limb Function ◽

Upper Limb Function ◽

Significant Difference ◽

Post Test ◽

Experimental Group

Objective: The study was conducted to assess the Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana. Study objectives were to (i) Assess the upper limb function among the clients with Modified Radical Mastectomy before the intervention. (ii) Demonstrate post-operative upper limb function exercises to the clients with breast cancer posted for Modified Radical Mastectomy. (iii) Assess the effectiveness of post-operative exercises on upper limb function among clients with Modified Radical Mastectomy. (iv) Find out the association between the upper limb function among clients with Modified Radical Mastectomy and selected variables. Methodology: Quantitative evaluative research approach was used for this study. The study was conducted at selected cancer hospitals, Hyderabad, Telangana. Pre-test post-test group only design adopted. The sample comprised of 30, 15 sample taken as experimental group,15 sample taken as experimental group. Sample was selected by purposive sampling technique. The data was collected by observational checklist. Results: The results revealed that pretest mean score was 64.03 and after intervention the post-test mean score was 57.16 there was a significant difference between the pre-test and post test scores from day 1 to day 5 of the clients at the level of p= 0.05, computed ‘t’ value is more than table value hence null hypothesis was rejected. The obtained’ value was 8.15, found greater than ‘t’ table value. Conclusion: The study concluded that most of the sample was improved upper limb function from day 1to day 5. There is a significant difference between pretest and post- test scores, The findings point out that demonstration of teaching programme would improve the upper limb function of clients with Modified Radical Mastectomy.

Download Full-text

Effectiveness of ultrasound guided ethanol motor points block in reduction of spasticity and improvement of upper limb function in hemiplegic patients: a randomized controlled study

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203606 ◽

2020 ◽

Vol 7 (9) ◽

pp. 1409

Author(s):

Sreejith C. ◽

Akoijam Joy Singh ◽

Longjam Nilachandra Singh ◽

Kanti Rajkumari ◽

Margaret Chabungbam ◽

...

Keyword(s):

Upper Limb ◽

Randomized Controlled Study ◽

Controlled Study ◽

Control Group ◽

Ultrasound Guided ◽

Limb Function ◽

Ethanol Injection ◽

Randomized Controlled ◽

Upper Limb Function ◽

Group A

Background: Stroke is the third leading cause of disability in general population commonly causing upper motor neuron syndrome complications like spasticity, which is more common in upper limb. Ethanol injection into spastic muscle is an emerging effective treatment in the spasticity management. Ethanol causes selective destruction of nerve fibers through denaturation of protein.Methods: A randomized controlled study was conducted for a period of 2 years from March 2018 on sixty-eight hemiplegic patients to assess the effectiveness of ethanol muscle block in reduction of spasticity and improvement in functional ability. The patients were allocated into two groups (Group A and B). Group A received ultrasound guided intramuscular ethanol injection along with range of motion (ROM) exercises and wrist hand orthosis (WHO) and Group B received ROM exercises and WHO. The outcomes were measured by modified ashworth scale (MAS) for spasticity and modified version of motor assessment scale for functional improvement.Results: Intervention group showed significant improvement in spasticity shown by reduction of MAS of elbow flexors from 3 at baseline to 1.15±0.3 at 12 weeks as compared to control group with 3 at baseline to 1.76±0.5 at 12 weeks (p<0.05). Upper limb function scale of study group improved from 1.5±0.8 to 3.0±0.6 at 12 weeks compared to control group 1.3±0.8 to 2.8±0.6 (p<0.05).Conclusions: It can thus be concluded that intramuscular injection of ethanol accompanied by wrist hand orthosis have beneficial effect on improvement of spasticity and upper limb function.

Download Full-text

Effect of Self-care Training on Upper Limb Function and Pain After Breast Cancer Surgery

Medical - Surgical Nursing Journal ◽

10.5812/msnj.121095 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Somyye Noura ◽

Fatemeh Kiani ◽

Nezarali Moulaei ◽

Mojtaba Tasbandi ◽

Ebrahim Ebrahimi Tabas

Keyword(s):

Breast Cancer ◽

Upper Limb ◽

Intervention Group ◽

Self Care ◽

Control Group ◽

Limb Function ◽

Upper Limb Function ◽

Care Training ◽

The Mean ◽

And Control

Background: Breast cancer patients who undergo mastectomy encounter numerous problems, the most annoying of which is lymphedema followed by pain and decreased function in the affected limb. Objectives: This study examined the effect of self-care training on upper limb function and pain after breast surgery. Methods: This quasi-experimental study was performed on two groups of 60 patients with breast cancer in the Oncology Ward of Zahedan University of Medical Sciences in 2021. The patients were selected based on the inclusion criteria and through convenience sampling and were then randomly divided into intervention and control groups. The patients in the intervention group attended self-care training and exercise programs implemented in five sessions in addition to the routine care. One and three months after the intervention, upper limb function and pain were measured with DASH and McGill pain questionnaires. The repeated measures analysis of variance (ANOVA) and Bonferroni test were used to compare the pre-, and post-intervention mean scores and mean differences in the two groups. Results: The mean scores of upper limb function one and three months after the training program in the intervention group were lower than the mean scores of the control group. In other words, the quality of upper limb function was not significantly different despite the changes in the first month, but upper limb function significantly improved three months after the intervention (P < 0.001 vs. P = 0.06). The mean pain scores before, one month, and three months after the intervention in the intervention group were 10.4, 35.7, and 6.26, respectively, and the corresponding values in the control group were 10.8, 41.7, and 21.1, respectively, showing significant differences between the two groups, with the intervention group having lower pain scores than the control group (P = 0.001). Conclusions: Since lymphedema and its consequences, including decreased upper limb function and pain, are very serious issues, medical staff can give priority to this training program and implement it to prevent and control these complications.

Download Full-text