Sensorimotor vs. Motor Upper Limb Therapy for Patients With Motor and Somatosensory Deficits: A Randomized Controlled Trial in the Early Rehabilitation Phase After Stroke

Background: Somatosensory function plays an important role in motor learning. More than half of the stroke patients have somatosensory impairments in the upper limb, which could hamper recovery.Question: Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy?Design: Randomized assessor- blinded multicenter controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke.Participants: 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation center.Intervention: Both groups received 16 h of additional therapy over 4 weeks consisting of sensorimotor (N = 22) or motor (N = 18) UL therapy.Outcome measures: Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after 4 weeks follow-up.Results: No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention [mean (SD) improvement 14.65 (2.19) vs. 5.99 (2.06); p = 0.01] and from baseline to follow-up [17.38 (2.37) vs. 6.75 (2.29); p = 0.003].Conclusion: UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may be less effective for motor recovery.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03236376.

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Sensorimotor upper limb therapy does not improve somatosensory function and may negatively interfere with motor recovery: a randomized controlled trial in the early rehabilitation phase after stroke

10.1101/2020.09.15.20194845 ◽

2020 ◽

Author(s):

Nele De Bruyn ◽

Leen Saenen ◽

Liselot Thijs ◽

Annick Van Gils ◽

Eva Ceulemans ◽

...

Keyword(s):

Upper Limb ◽

Controlled Trial ◽

Motor Impairment ◽

Motor Recovery ◽

Early Rehabilitation ◽

Rehabilitation Centre ◽

Post Intervention ◽

Therapy Design ◽

Somatosensory Function

Question: Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy? Design: Randomised assessor- blinded multi-centre controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke. Participants: 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation centre Intervention: Both groups received 16 hours of additional therapy over four weeks consisting of sensorimotor (N=22) or motor (N=18) UL therapy. Outcome measures: Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after four weeks follow-up. Results: No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention (mean (SD) improvement 14.65 (2.19) versus 5.99 (2.06); p=0.01) and from baseline to follow-up (17.38 (2.37) versus 6.75 (2.29); p=0.003). Conclusion: UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may negatively influence motor recovery.

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Bilateral Transcutaneous Electrical Nerve Stimulation Improves Upper Limb Motor Recovery in Stroke: A Randomized Controlled Trial

Stroke ◽

10.1161/strokeaha.121.036895 ◽

2021 ◽

Author(s):

Peiming Chen ◽

Tai-Wa Liu ◽

Patrick W.H. Kwong ◽

Claudia K.Y. Lai ◽

Raymond C.K. Chung ◽

...

Keyword(s):

Upper Extremity ◽

Upper Limb ◽

Nerve Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Controlled Trial ◽

Motor Recovery ◽

Mean Difference ◽

Post Intervention ◽

Electrical Nerve Stimulation

Background and Purpose: Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. Methods: This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. Results: Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P =0.004), Placebo-TENS+TOT (mean difference, 2.63; P <0.001), and Control groups (mean difference, 3.11; P <0.001) at post-intervention. Both Bi-TENS+TOT (mean difference, 3.39; P <0.001) and Uni-TENS+TOT (mean difference, 1.26; P =0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. Conclusions: Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03112473.

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Standard early rehabilitation and lower limb transcutaneous nerve or neuromuscular electrical stimulation in acute stroke patients: a randomized controlled pilot study

Clinical Rehabilitation ◽

10.1177/0269215519841420 ◽

2019 ◽

Vol 33 (8) ◽

pp. 1344-1354 ◽

Cited By ~ 1

Author(s):

Hsiao-Ching Yen ◽

Wen-Shiang Chen ◽

Jiann-Shing Jeng ◽

Jer-Junn Luh ◽

Ya-Yun Lee ◽

...

Keyword(s):

Electrical Stimulation ◽

Acute Stroke ◽

Nerve Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Early Rehabilitation ◽

Stroke Patients ◽

Post Intervention ◽

Transcutaneous Nerve Stimulation ◽

Stroke Center

Objective:We investigated adding lower limb transcutaneous nerve stimulation or neuromuscular electrical stimulation to standard early rehabilitation in acute stroke patients.Design:An assessor-blinded, randomized controlled pilot study.Setting:A medical stroke center.Subjects:First-stroke patients aged 20–80 years admitted to the stroke center within 24 hours post stroke.Interventions:A total of 42 participants were randomly assigned to groups: transcutaneous nerve stimulation + standard early rehabilitation, neuromuscular electrical stimulation + standard early rehabilitation, or standard early rehabilitation-only. Transcutaneous nerve or neuromuscular electrical stimulation was delivered to the affected tibialis anterior and quadriceps muscles for 30 minutes a day, five days per week for two weeks.Main measures:The Postural Assessment Scale for Stroke Patients, the Functional Independence Measure, and three mobility milestones, namely, sitting for >five minutes, standing for >one minute, and walking ⩾50 m, were evaluated, respectively, at baseline, at the two-week post-intervention, and at two-week follow-up.Results:Significant differences existed in the Postural Assessment Scale for Stroke Patients scores between the transcutaneous nerve stimulation and standard early rehabilitation-only groups measured at two-weeks post-intervention (mean (SD) = 31.38 (5.39) and 18.00 (8.65), respectively) and at the two-week follow-up (34.08 (2.69) and 26.14 (7.77), respectively). A higher proportion of participants could walk ⩾50 m independently in the transcutaneous nerve stimulation group than in the standard early rehabilitation-only group at the two-week post-intervention ( P = 0.013) and two-week follow-up ( P = 0.01) marks.Conclusion:Two weeks of transcutaneous nerve stimulation added to standard early rehabilitation improved postural stability and walking in acute stroke patients.

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Randomised controlled trial and economic evaluation of a targeted cancer awareness intervention for adults living in deprived areas of the UK

British Journal of Cancer ◽

10.1038/s41416-021-01524-5 ◽

2021 ◽

Author(s):

Yvonne Moriarty ◽

Mandy Lau ◽

Bernadette Sewell ◽

Rob Trubey ◽

Harriet Quinn-Scoggins ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Cancer Awareness ◽

Post Intervention ◽

Clinical Trial Registration ◽

Symptom Recognition ◽

Randomised Controlled ◽

Post Randomisation ◽

Deprived Areas

Abstract Background Cancer outcomes are poor in socioeconomically deprived communities, with low symptom awareness contributing to prolonged help-seeking and advanced disease. Targeted cancer awareness interventions require evaluation. Methods This is a randomised controlled trial involving adults aged 40+ years recruited in community and healthcare settings in deprived areas of South Yorkshire and South-East Wales. Intervention: personalised behavioural advice facilitated by a trained lay advisor. Control: usual care. Follow-up at two weeks and six months post-randomisation. Primary outcome: total cancer symptom recognition score two weeks post-randomisation. Results Two hundred and thirty-four participants were randomised. The difference in total symptom recognition at two weeks [adjusted mean difference (AMD) 0.6, 95% CI: −0.03, 1.17, p = 0.06] was not statistically significant. Intervention participants reported increased symptom recognition (AMD 0.8, 95% CI: 0.18, 1.37, p = 0.01) and earlier intended presentation (AMD −2.0, 95% CI: −3.02, −0.91, p < 0.001) at six months. “Lesser known” symptom recognition was higher in the intervention arm (2 weeks AMD 0.5, 95% CI: 0.03, 0.97 and six months AMD 0.7, 95% CI: 0.16, 1.17). Implementation cost per participant was £91.34, with no significant between-group differences in healthcare resource use post-intervention. Conclusions Improved symptom recognition and earlier anticipated presentation occurred at longer-term follow-up. The ABACus Health Check is a viable low-cost intervention to increase cancer awareness in socioeconomically deprived communities. Clinical trial registration ISRCTN16872545.

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Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01795-6 ◽

2021 ◽

Author(s):

Bente Storm Mowatt Haugland ◽

Mari Hysing ◽

Asle Hoffart ◽

Åshild Tellefsen Haaland ◽

Jon Fauskanger Bjaastad ◽

...

Keyword(s):

Early Intervention ◽

Standard Length ◽

Sleep Problems ◽

Sleep Onset ◽

Cognitive Behavioral ◽

Control Group ◽

Sleep Onset Latency ◽

Post Intervention ◽

Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p < 0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

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A Short Mindfulness Retreat for Students to Reduce Stress and Promote Self-Compassion: Pilot Randomised Controlled Trial Exploring Both an Indoor and a Natural Outdoor Retreat Setting

Healthcare ◽

10.3390/healthcare9070910 ◽

2021 ◽

Vol 9 (7) ◽

pp. 910

Author(s):

Dorthe Djernis ◽

Mia S. O’Toole ◽

Lone O. Fjorback ◽

Helle Svenningsen ◽

Mimi Y. Mehlsen ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Effect Sizes ◽

Medium Effect ◽

Control Group ◽

Post Intervention ◽

Pilot Randomised Controlled Trial ◽

Self Compassion ◽

Randomised Controlled

Here, we developed and examined a new way of disseminating mindfulness in nature to people without meditation experience, based on the finding that mindfulness conducted in natural settings may have added benefits. We evaluated a 5-day residential programme aiming to reduce stress and improve mental health outcomes. We compared an indoor and an outdoor version of the programme to a control group in a pilot randomised controlled trial (RCT). Sixty Danish university students experiencing moderate to high levels of stress were randomised into a residential mindfulness programme indoors (n = 20), in nature (n = 22), or a control group (n = 18). Participants completed the Perceived Stress Scale and the Self-Compassion Scale (primary outcomes) along with additional secondary outcome measures at the start and end of the program and 3 months after. Stress was decreased with small to medium effect sizes post-intervention, although not statistically significant. Self-compassion increased post-intervention, but effect sizes were small and not significant. At follow-up, changes in stress were not significant, however self-compassion increased for both interventions with medium-sized effects. For the intervention groups, medium- to large-sized positive effects on trait mindfulness after a behavioural task were found post-intervention, and small- to medium-sized effects in self-reported mindfulness were seen at follow-up. Connectedness to Nature was the only outcome measure with an incremental effect in nature, exceeding the control with a medium-sized effect at follow-up. All participants in the nature arm completed the intervention, and so did 97% of the participants in all three arms. Overall, the results encourage the conduct of a larger-scale RCT, but only after adjusting some elements of the programme to better fit and take advantage of the potential benefits of the natural environment.

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A randomised controlled trial to investigate the effectiveness of sustained photoprotective behaviour in xeroderma pigmentosum after intervention

BJPsych Open ◽

10.1192/bjo.2021.764 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S287-S287

Author(s):

Tamara Searle ◽

Jessica Walburn ◽

Sam Norton

Keyword(s):

Randomised Controlled Trial ◽

Self Efficacy ◽

Xeroderma Pigmentosum ◽

Controlled Trial ◽

Premalignant Lesions ◽

Mental Wellbeing ◽

Group Effect ◽

Post Intervention ◽

Randomised Controlled

AimsThis study aimed to investigate whether an intervention designed to improve photoprotective behaviours is effective at changing behaviour and whether any change could be maintained.BackgroundXeroderma Pigmentosum (XP) is a rare condition in which patients are at risk of malignancies when exposed to ultra-violet radiation (UVR). Sufferers must take extra precautions to protect themselves from UVR. They must apply sunscreen to exposed skin, wear thick clothing, gloves, and a UVR-protective visor. Treatments include preventative photoprotective measures; the use of sunscreen and protective clothing. Additionally, frequent eye and skin examinations are required and swift removal of any premalignant lesions.MethodIn this randomised controlled trial, 16 participants with XP were given questionnaires at 4 time points; baseline, post-intervention, 5 months and 9 months post-intervention. The intervention involved 7 one-on-one counselling sessions, as well as telephone consultations. Counselling sessions encouraged photoprotection adherence, self-efficacy and discussions of any barriers to improving photoprotective behaviour. This study focused on psychosocial variables, attitudes and photoprotection. Questionnaires included the photoprotection self-efficacy questionnaire, Self-Reported Behavioural Automaticity Index, Short Warwick-Edinburgh Mental Wellbeing Scale, Quality of Life and Brief Photoprotection Adherence Questionnaire.ResultThe intervention was shown to have no significant effect on participants’ questionnaires scores. Univariate ANCOVA revealed a group effect between follow-up 1 (FU1) and follow-up 2 (FU2); η2 = 0.422 for self-efficacy in wearing photoprotective clothing. A group effect was identified from BL to FU1 and FU1 to FU2; η2 = 0.343 and η2 = 0.378 respectively in how often participants reapplied sunscreen to their face when outside for longer periods. Univariate ANCOVA revealed no group or time effect for the other outcome variables; for example, sunscreen self-efficacy.ConclusionThe intervention had no significant effect on photoprotective behaviour questionnaire scores. Future research could focus on recruiting more participants globally to generate more statistically powered results. Research should focus on producing a maintainable intervention so that any positive change would produce better long-term health outcomes. This study lays the foundations for future XP research, which will be vital to improve understanding and enhance photo protective behaviour.

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Abstract WP412: Low Concordance Rates of Dysphagia Screening in Stroke Patients Evaluated by Neuroscience Nurses and Speech-Language Pathologists

Stroke ◽

10.1161/str.48.suppl_1.wp412 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Laura Beth Durm ◽

Julie Bonner ◽

Ellen Meyer ◽

Cyndy Brasher ◽

Stuart Schleuse ◽

...

Keyword(s):

Oral Intake ◽

Stroke Patients ◽

Post Intervention ◽

Nursing Assessment ◽

Clinical Nurse Specialists ◽

Speech Language Pathologist ◽

Neuroscience Nursing ◽

Water Test ◽

High Concordance

Background: While there is recognition about the importance of dysphagia screens in stroke patients, there is limited data on the concordance rates of dysphagia screens performed by neuroscience-trained nurses and speech language pathologist (SLPs). Hypothesis: Neuroscience nurses and SLPs will have high concordance rates when assessing stroke patients with dysphagia screens. Methods: From March 1, 2016 through May 31, 2016 a random sample of stroke patients underwent a dysphagia screening by neuroscience nurses and subsequently by SLPs within 24 hours using the same tool, a 2-part screen assessing for contraindications and using the 3-ounse water swallow test. Results of the dysphagia screens were retrospectively collected to identify concordance rates. Results: During the study period, 98% of stroke patients underwent dysphagia screening prior to oral intake. Of 50 stroke patients evaluated by neuroscience nurses and SLPs, only 26 patients (52%) demonstrated concordance with pass or fail results. Of 33 patients who were administered the water test and passed the dysphagia screen based on the neuroscience nursing assessment, 20 patients (61%) were determined by SLPs evaluation to have dysphagia and 11 (33%) of these patients had had overt aspiration. Conclusions: Current metrics on dysphagia screening do not identify the efficacy of dysphagia screening among stroke patients. Stroke centers who utilize bedside nurses to perform initial dysphagia screens should evaluate concordance rates with SLPs. A multidisciplinary team including Clinical Nurse Specialists, SLPs, and Nursing IT specialists have implemented measures (hospital wide re-education of nursing staff and optimizing the electronic dysphagia screening form) to improve concordance rates among nurses and SLPs. A post-intervention follow-up study of concordance rates among neurosciences and SLPs is underway.

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