Effects of Robot-Aided Rehabilitation on the Ankle Joint Properties and Balance Function in Stroke Survivors: A Randomized Controlled Trial

Background: Stroke survivors with impaired control of the ankle due to stiff plantarflexors often experience abnormal posture control, which affects balance and locomotion. Forceful stretching may decrease ankle stiffness and improve balance. Recently, a robot-aided stretching device was developed to decrease ankle stiffness of patient post-stroke, however, their benefits compared to manual stretching exercises have not been done in a randomized controlled trial, and the correlations between the ankle joint biomechanical properties and balance are unclear.Objective: To compare the effects of robot-aided to manual ankle stretching training in stroke survivors with the spastic ankle on the ankle joint properties and balance function post-stroke, and further explore the correlations between the ankle stiffness and balance.Methods: Twenty inpatients post-stroke with ankle spasticity received 20 minutes of stretching training daily over two weeks. The experimental group used a robot-aided stretching device, and the control group received manual stretching. Outcome measures were evaluated before and after training. The primary outcome measure was ankle stiffness. The secondary outcome measures were passive dorsiflexion ranges of motion, dorsiflexor muscle strength, Modified Ashworth Scale (MAS), Fugl-Meyer Motor Assessment of Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and the Pro-Kin balance test.Results: After training, two groups showed significantly within-group improvements in dorsiflexor muscle strength, FMA-LE, BBS, MBI (P < 0.05). The between-group comparison showed no significant differences in all outcome measures (P > 0.0025). The experimental group significantly improved in the stiffness and passive range of motion of dorsiflexion, MAS. In the Pro-Kin test, the experimental group improved significantly with eyes closed and open (P < 0.05), but significant improvements were found in the control group only with eyes open (P < 0.05). Dorsiflexion stiffness was positively correlated with the Pro-Kin test results with eyes open and the MAS (P < 0.05).Conclusions: The robot-aided and manual ankle stretching training provided similar significant improvements in the ankle properties and balance post-stroke. However, only the robot-aided stretching training improved spasticity and stiffness of dorsiflexion significantly. Ankle dorsiflexion stiffness was correlated with balance function.Clinical Trial Registration:www.chictr.org.cn ChiCTR2000030108.

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Effects of Robot-Aided Rehabilitation on Improving Ankle and Balance Performance of Stroke Survivors: A Randomized Controlled Trial

10.21203/rs.3.rs-131928/v1 ◽

2020 ◽

Author(s):

Xiaoxue Zhai ◽

Qiong Wu ◽

Xin Li ◽

Quan Xu ◽

Yanlin Zhang ◽

...

Keyword(s):

Standard Deviation ◽

Controlled Trial ◽

Biomechanical Properties ◽

Control Group ◽

Study Group ◽

Stroke Survivors ◽

Eyes Closed ◽

Ankle Stiffness ◽

Ankle Rehabilitation ◽

Eyes Open

Abstract Background: Stroke survivors with impaired ankle control due to stiff plantar flexors often experience abnormal posture control, which affects balance and locomotion. Forceful and safe stretching under intelligent control may decrease ankle stiffness and improve balance. The purpose of this study was to investigate the effects of robot-aided ankle rehabilitation on stroke survivors with ankle spasticity and the correlations between biomechanical properties and balance in these participants. Methods: Twenty patients poststroke with ankle spasticity received 20 minutes of stretching treatment daily over 2 weeks. The study group used a robot-aided ankle rehabilitation and the control group received manual stretching. Outcome measures included biomechanical, clinical evaluations, and the Pro-Kin balance test.Results: The study group significantly improved in joint stiffness and range of motion of dorsiflexion, Modified Ashworth Scale (MAS), trajectory lengths, elliptical trajectory, standard deviation medial/lateral, average speed forward/backward with eyes closed, and standard deviation forward/backward with eyes open in the Pro-Kin test (P<.05), but no significant changes were found in the control group in above indexes; significant decreases were found in the control group in trajectory length with eyes open (P<.05); dorsiflexion stiffness was positively correlated with the Pro-Kin test outcomes with eyes open and the MAS; no between-group significant changes were found except the activities of daily living after training (P<.05).Conclusions: Ankle stiffness may affect balance poststroke significantly. The robot-aided ankle rehabilitation improved biomechanical properties of the spastic ankle including stiffness, and it may help improve balance post-stroke.Trial registration: www.chictr.org.cn ChiCTR2000030108. Registered 23 February 2020. Retrospectively registered.

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Feasibility of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00886-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kristina Traxler ◽

Franz Schinabeck ◽

Eva Baum ◽

Edith Klotz ◽

Barbara Seebacher

Keyword(s):

Randomised Controlled Trial ◽

Ankle Joint ◽

Manual Therapy ◽

Controlled Trial ◽

Daily Activities ◽

Control Group ◽

Chronic Stage ◽

Post Stroke ◽

Randomised Controlled ◽

Task Oriented

Abstract Background Large studies have shown that stroke is among the most relevant causes of acquired adult disability. Walking and balance impairment in stroke survivors often contribute to a restriction in daily activities and social participation. Task-oriented training (TOT) is an effective treatment strategy and manual therapy (MT) is used successfully to enhance ankle joint flexibility in this population. No study, however, has compared TOT against its combination with MT in a randomised controlled trial. Aims of this pilot study are therefore to explore the feasibility of a full-scale RCT using predefined feasibility criteria. Secondary aims are to explore the preliminary effects of specific TOT with a combined specific TOT-MT versus a control group in people post stroke. Methods This is a protocol of a 4-week prospective randomised controlled parallel pilot trial in people post stroke at the chronic stage with limited upper ankle joint mobility and an impairment in balance and mobility. At a German outpatient therapy centre using 1:1:1 allocation, 36 patients will be randomised into one of three groups: 15-min talocrural joint MT plus 30-min specific TOT (group A), 45-min specific TOT (group B), and controls (group C). Training will be goal-oriented including tasks that are based on daily activities and increased in difficulty utilising predefined progression criteria based on patients’ skill levels. Interventions will be provided face-to-face 2 times per week, for 4 weeks, in addition to 20-min concurrent x4 weekly home-based training sessions. Data will be collected by blinded assessors at baseline, post-intervention and 4-week follow-up. The primary outcome will be feasibility assessed by recruitment, retention and adherence rates, compliance, adverse events, falls and the acceptability of the intervention. Secondary outcomes will be walking speed, single and dual tasking functional mobility, ankle range of motion, disability and health-related quality of life. Discussion Feasibility provided, results from this study will be used to calculate the sample size of a larger randomised controlled trial to investigate the effects of specific TOT and specific TOT-MT compared to a post stroke control group. Trial registration German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068.

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Effects of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial

10.21203/rs.3.rs-132414/v1 ◽

2020 ◽

Author(s):

Kristina Traxler ◽

Franz Schinabeck ◽

Eva Baum ◽

Edith Klotz ◽

Barbara Seebacher

Keyword(s):

Randomised Controlled Trial ◽

Ankle Joint ◽

Manual Therapy ◽

Controlled Trial ◽

Daily Activities ◽

Control Group ◽

Chronic Stage ◽

Post Stroke ◽

Randomised Controlled ◽

Task Oriented

Abstract Background: Large studies have shown that stroke is among the most relevant causes of acquired adult disability. Walking and balance impairment in stroke survivors often contribute to a restriction in daily activities and social participation. Task-oriented training (TOT) is an effective treatment strategy and manual therapy (MT) is used successfully to enhance ankle joint flexibility in this population. No study, however, has compared TOT against its combination with MT in a randomised controlled trial. Aims of this pilot study are therefore to explore the feasibility of a full-scale RCT and the preliminary effects of specific TOT with a combined specific TOT-MT versus a control group in people post stroke.Methods: This is a protocol of a 4-week prospective randomised controlled parallel pilot trial in people post stroke at the chronic stage with limited upper ankle joint mobility and an impairment in balance and mobility. At a German outpatient therapy centre using 1:1:1 allocation, 36 patients will be randomised into one of three groups: 15-minute talocrural joint MT plus 30-minute specific TOT (Group A); 45-minute specific TOT (Group B); controls (Group C). Training will be goal-oriented including tasks that are based on daily activities and increased in difficulty ulilising predefined progression criteria. Interventions will be provided face-to-face 2 times per week, for 4 weeks, in addition to 20-minute concurrent x4 weekly homebased training sessions. Data will be collected by blinded assessors at baseline, post-intervention and 4-week follow-up. The primary outcome will be feasibility assessed by recruitment, retention and adherence rates, compliance, adverse events, falls and the acceptability of the intervention. Secondary outcomes will be walking speed, single and dual tasking functional mobility, ankle range of motion, disability and health-related quality of life.Discussion: Results from this study will inform a larger randomised controlled trial to investigate the effects of specific TOT and specific TOT-MT compared to a post stroke control group. We hope that the study findings help to enhance stroke rehabilitation.Trial registration: German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068.

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Effects of Intermittent Pneumatic Compression on Lower Limb Lymphedema in Patients with Type 2 Diabetes Mellitus: A Pilot Randomized Controlled Trial

Medicina ◽

10.3390/medicina57101018 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1018

Author(s):

Alessandro de Sire ◽

Maria Teresa Inzitari ◽

Lucrezia Moggio ◽

Monica Pinto ◽

Giustino de Sire ◽

...

Keyword(s):

Diabetes Mellitus ◽

Outcome Measures ◽

Lower Limb ◽

Controlled Trial ◽

Group Analysis ◽

Intermittent Pneumatic Compression ◽

Control Group ◽

Interstitial Tissue ◽

Experimental Group

Background and Objectives: Diabetes mellitus type 2 (T2DM) is a chronic disease associated with fluid accumulation in the interstitial tissue. Manual lymphatic drainage (MLD) plays a role in reducing lymphoedema, like intermittent pneumatic compression (IPC). By the present pilot study, we aimed to evaluate the efficacy of a synergistic treatment with MLD and IPC in reducing lower limb lymphedema in T2DM patients. Materials and Methods: Adults with a clinical diagnosis of T2DM and lower limb lymphedema (stage II–IV) were recruited from July to December 2020. Study participants were randomized into two groups: experimental group, undergoing a 1-month rehabilitative program consisting of MLD and IPC (with a compression of 60 to 80 mmHg); control group, undergoing MLD and a sham IPC (with compression of <30 mmHg). The primary outcome was the lower limb lymphedema reduction, assessed by the circumferential method (CM). Secondary outcomes were: passive range of motion (pROM) of hip, knee, and ankle; quality of life; laboratory exams as fasting plasma glucose and HbA1c. At baseline (T0) and at the end of the 1-month rehabilitative treatment (T1), all the outcome measures were assessed, except for the Hb1Ac evaluated after three months. Results: Out of 66 T2DM patients recruited, only 30 respected the eligibility criteria and were randomly allocated into 2 groups: experimental group (n = 15; mean age: 54.2 ± 4.9 years) and control group (n = 15; mean age: 54.0 ± 5.5 years). At the intra-group analysis, the experimental group showed a statistically significant improvement of all outcome measures (p < 0.05). The between-group analysis showed a statistically significant improvement in pROM of the hip, knee, ankle, EQ-VAS, and EQ5D3L index at T1. Conclusions: A multimodal approach consisting of IPC and MLD showed to play a role in reducing lower limb lymphedema, with an increase of pROM and HRQoL. Since these are preliminary data, further studies are needed.

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Effect of Six Weeks Cycle Ergometry on Selected Gait Parameters of Stroke Survivors

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2010.1306 ◽

2010 ◽

Author(s):

Ayodele Onigbinde ◽

Moruf Mustapha

Keyword(s):

Conventional Therapy ◽

Gait Cycle ◽

Cycle Ergometer ◽

Cycle Ergometry ◽

Control Group ◽

Stroke Survivors ◽

Post Stroke ◽

Gait Parameters ◽

Heel Contact ◽

Experimental Group

Purpose: Restoration of gait in stroke survivors is a major goal in rehabilitation. Recently, treadmill training has been introduced as a measure to improve the post stroke gait pattern, but there is still limited data on the use of the cycle ergometer. The primary aim was to compare selected gait parameters of hemiplegics subjects who received cycle ergometry and those who had traditional physiotherapy. Method: A total of twenty-four (24) subjects were alternately allocated to 2 groups, but only 20 completed the experimental procedure. The two groups received baseline traditional physiotherapy while the experimental group used a cycle ergometer as an addition. Participants pedaled at a predetermined cadence of 50 rpm until the participant indicated that he or she could not pedal any longer, and this training was repeated 3 times per week for 6 weeks. To measure outcomes, the participants were instructed to walk on a 3-meter walkway with sprinkled powder to show the footprints. The prints were then utilized to measure the selected parameters (step length, stride length and step width). The period of time from one heel contact of one foot to the following occurrence of the same event with the same foot is taken as gait cycle, while cadence was determined as number of steps per minute. The Wisconsin gait scale was used to measure any changes in the affected limb. Descriptive statistics and Analysis of variance (ANOVA) were used to analyze the data. Results: The initial cadence of the experimental group was 42.17steps/minute while the final was 64.00steps/min. Also, the initial cadence of the control group was 40.50steps/min while the final was 52.25steps/min. Similarly, the gait cycle improved from 20.83 seconds to 31.67 seconds for the experimental group while that of the control group improved from 20.00 to 25.75 seconds. This showed that there was significant improvement in cadence (p < 0.00) and gait cycle (p < 0.00) when cycle ergometry was combined with conventional therapy compared to those who had only conventional therapy. Also, the Wisconsin Gait Scale score improved significantly for the experimental group (p < 0.02). Conclusion: This study concluded that selected parameters of the gait of people post-stroke were improved when cycle ergometry was combined with conventional therapy. Further research is indicated.

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Qigong for Muscle Strength and Static Postural Control in Middle-Aged and Older Postmenopausal Women: A Randomized Controlled Trial

Frontiers in Medicine ◽

10.3389/fmed.2021.784320 ◽

2021 ◽

Vol 8 ◽

Author(s):

María del Carmen Carcelén-Fraile ◽

Agustín Aibar-Almazán ◽

Antonio Martínez-Amat ◽

Vânia Brandão-Loureiro ◽

José Daniel Jiménez-García ◽

...

Keyword(s):

Muscle Strength ◽

Postural Control ◽

Postmenopausal Women ◽

Center Of Pressure ◽

Controlled Trial ◽

Exercise Program ◽

Control Group ◽

Middle Aged ◽

Eyes Open ◽

Experimental Group

In the present study, we aimed to determine the effects of a Qigong exercise program on the muscle strength and postural control in middle-aged and older postmenopausal women. This is a randomized clinical trial (https://clinicaltrials.gov/ct2/show/NCT03989453) conducted on 125 women who were initially assigned to either an experimental group (n = 63) that performed a Qigong exercise program for 12 weeks or to a control group (n = 62) that did not receive any intervention. Muscle strength (dynamometer) and postural control (stabilometric platform) were evaluated before and immediately after an intervention period. The main findings of this study suggest that the women in the experimental group had improvements in muscle strength, mean velocity of the displacement of the center of pressure (CoP) with both eyes open and closed, and the surface sway area covered by the CoP, as well as the mediolateral and anteroposterior oscillations of the CoP, only with eyes open. The results of the present study determined that a 12 week Qigong exercise program has beneficial effects on muscle strength and postural control of middle-aged and older postmenopausal Spanish women.

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Therapeutic effect of gradual attention training on language function in patients with post-stroke aphasia: a pilot study

Clinical Rehabilitation ◽

10.1177/0269215519864715 ◽

2019 ◽

Vol 33 (11) ◽

pp. 1767-1774 ◽

Cited By ~ 1

Author(s):

Hong Zhang ◽

He Li ◽

Ruojin Li ◽

Guoxing Xu ◽

Zhenlan Li

Keyword(s):

Controlled Trial ◽

Attention Training ◽

Control Group ◽

Language Function ◽

Auditory Comprehension ◽

Post Stroke ◽

The Mean ◽

One Year ◽

And Control ◽

Experimental Group

Objective: To investigate the effect of gradual attention training on language function with aphasia. Design: Randomized controlled trial. Participants: A total of 40 patients (mean age: 53.47 years) with post-stroke aphasia came from the stroke rehabilitation unit of rehabilitation department in the First Hospital of Jilin University, of which 13 (32.5%) had intracerebral hemorrhage, 28 inpatients and 12 outpatients, 11 women and 29 men, 34 within three-month stroke and 6 within three months to one year. Interventions: All participants were divided into control and experimental groups. Both groups received language treatment 20 minutes a day, six days/week, for five weeks, and the experimental group received gradual attention training 20 minutes a day, six days/week, for five weeks. Main measures: Language function was assessed pre- and post-treatment by components of the Western Aphasia Battery (WAB) which included spontaneous speech, auditory comprehension, repetition, and naming and then calculated the aphasia quotient (AQ). Results: The mean (SD) AQ of the experimental group and control group, respectively, was 25.71 (12.63) and 26.2 (12.31) at baseline. After treatment, the AQ mean (SD) was 43.08 (15.14) in the experimental group, which showed a significant improvement compared to 33.48 (14.04) in the control group ( P = 0.02).All items of WAB were higher in experimental group than those in control group, especially in auditory comprehension and naming ( P = 0.02, 0.01). Conclusion: Gradual attention training seemed to improve language function in post-stroke aphasia, specifically function of listening comprehension and naming.

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

Journal of Clinical Medicine ◽

10.3390/jcm10194549 ◽

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.

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Efficacy of axial TheraTogs on gait pattern in children with dyskinetic cerebral palsy: a randomized controlled trial

Bulletin of Faculty of Physical Therapy ◽

10.1186/s43161-021-00030-2 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Shamekh Mohamed El-Shamy ◽

Ehab Mohamed Abd El Kafy

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Muscle Tone ◽

Controlled Trial ◽

Gait Pattern ◽

Controlled Study ◽

Control Group ◽

Randomized Controlled ◽

Gait Parameters ◽

Experimental Group

Abstract Background TheraTogs promotes proprioceptive sense of a child with cerebral palsy and improves abnormal muscle tone, posture alignment, balance, and gait. Therefore, the aim of this study was to investigate the efficacy of TheraTogs orthotic undergarment on gait pattern in children with dyskinetic cerebral palsy. Thirty children with dyskinetic cerebral palsy were selected for this randomized controlled study. They were randomly assigned to (1) an experimental group that received TheraTogs orthotic undergarment (12 h/day, 3 days/week) plus traditional physical therapy for 3 successive months and (2) a control group that received only traditional physical therapy program for the same time period. Gait parameters were measured at baseline and after 3 months of intervention using Pro-Reflex motion analysis. Results Children in both groups showed significant improvements in the gait parameters (P < 0.05), with significantly greater improvements in the experimental group than in the control group. Conclusions The use of TheraTogs may have a positive effect to improve gait pattern in children with dyskinetic cerebral palsy. Trial registration This trial was registered in the ClinicalTrial.gov PRS (NCT03037697).

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Does soft tissue mobilization assist static stretching to improve hamstring flexibility? A randomized controlled trial

Journal of Complementary and Integrative Medicine ◽

10.1515/jcim-2019-0288 ◽

2020 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Shibili Nuhmani

Keyword(s):

Soft Tissue ◽

Controlled Trial ◽

Knee Extension ◽

Repeated Measure ◽

Control Group ◽

Static Stretching ◽

Significant Difference ◽

Hamstring Flexibility ◽

Soft Tissue Mobilization ◽

Experimental Group

AbstractObjectivesObjective of the study is to investigate whether Soft tissue mobilization (STM) can assist with static stretching to improve hamstring flexibly.MethodsThe design of the study was repeated measure design. The study was conducted at the physical therapy laboratory of Jamia Hamdard University, New Delhi. Participants included 78 healthy males with hamstring tightness, randomly assigned to either the control group (static stretching) or the experimental group (STM and static stretching). The experimental group received five sets of four different STM techniques, followed by two sets of 30-s static stretches 3 days per week over the course of 12 weeks. The control group received 5 min of sham ultrasound with an inactive probe prior to static stretching. Active knee extension test (AKE) was the outcome measure.ResultsBoth groups showed significant improvement in AKE compared with the baseline measurements. With ingroup analysis showed a significant difference in AKE across all measured time periods (weeks 4, 8, and 12) with pre-test in both groups (p<0.05). No significant difference in AKE improvement was found between groups (p>0.05).ConclusionThe results of this study show that STM prior to static stretching does not significantly improve hamstring flexibility among healthy individuals. Although this study cannot be generalized, the results may be useful for evidence-based practice in the management of hamstring tightness.

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