Combined Effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis

Telehealth use allows improved access to services and results in potential cost savings. The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy (mCIMT) program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity. Using a pre-experimental design with a 6-week intervention, 28 participants were assessed twice on use of upper extremity via subjective and objective measures. For the Motor Activity Log, the amount of use and quality of use were significant for Groups 1 and 2. Significant improvements were shown on the Wolf Motor Function Test (WMFT), the Fugl-Meyer UE, and the Functional Independence Measure (FIM) for both groups except for the strength subtest on the WMFT and the timed portion for Group 1. Percentages of attendance for telehealth and in-person sessions were also compared. Telehealth sessions had a higher attendance rate (84.5%) than in-person sessions (75.3%) (p=.004). The combined mCIMT program of telerehabilitation and in-person group sessions was effective in improving functional ability after a stroke.

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Effect of the complex physical therapy on the upper extremity function, functional independence and cognition in post-stroke patients

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.001768 ◽

2021 ◽

pp. 61-68

Author(s):

Iriah Uwa-Agbonikhena ◽

Viktoriia Gryb ◽

Viktoriia Gerasymchuk ◽

Marta Kupnovytska-Sabadosh ◽

Liubov Maksymchuk

Keyword(s):

Physical Therapy ◽

Upper Extremity ◽

Motor Function ◽

Hand Function ◽

Functional Independence ◽

Motor Dysfunction ◽

Extremity Function ◽

Upper Extremity Function ◽

Group 2 ◽

Group 1

Motor dysfunction and cognitive impairment (CI) are the most prevalent and disabling among the stroke consequences. CI decreases the effectivity of motor rehabilitation, but motor dysfunction itself may also influence the manifestations and progression of CI. So development and study of novel physical therapy tactics, which are aiming to target both of these syndromes, becomes a subject of great interest nowadays. The aim of study was to evaluate the impact of different physical therapy approaches on the upper extremity function, cognition and functional independence in patients in 1 year after ischemic stroke. Materials and methods. Totally there were 72 patients examined in the 1-year period after first-ever anterior circulation ischemic stroke. Neurological status, upper extremity function and functional independence were assessed with the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), modified Rankin Scale (mRS) and the Functional Independence Measurement (FIM). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Trail-making Test A and B tests (TMT). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for paretic hand function improvement for 2 months. Results. After 2 months of physical therapy a significant increase of the FIM “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in patients in Group 2; in Group 1 significant improvement was observed only in “Transfer” and subtotal motor scores. Adding of the hand exercise to the physical therapy complex (Group 2) appeared to be more beneficial for the upper extremity motor function. Patients in Group 2 after 2 months showed increase of the FMA “Wrist” score by 40 % (p<0.05), “Hand” score by 42.8 % (p<0.01) and “Total motor function” by 30.1 % (p<0.05), and the “Total motor function” score in Group 2 was 10.9 % higher in comparison with the Group 1 (p<0.05). In cognitive status significant differences compared to baseline level were observed only in Group 2; MoCA score increased by 14.3 % (p<0.05) and TMT-B performance time decreased by 14.8 % (p<0.05). Baseline MoCA score correlated with FMA “Wrist” (r=0.32; p=0.028), “Hand” (r=0.49; p=0.001) and “Total motor function” (r=0.46; p=0.004) scores. TMT-B score showed significant correlation with the FMA “Wrist” (r=-0.032; p=0.025), “Hand” (-0.45; p=0.009), “Speed/coordination” (r=-0.023; p=0.036) and “Total motor function” (r=-0.42; p=0.023). Conclusion. Adding of exercise for hand function improvement into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore is more favourable for patients’ functional independence. Upper extremity motor impairment, especially hand and wrist dysfunction, are associated with worse cognitive performance. Hand function and fine motor skills improvement could be beneficial for the patients’ cognition. Further research is needed in regard to the prognostic significance of these findings and their impact on the treatment and rehabilitation strategies.

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Evaluation of Functional Recovery by Motor Functional Independence Measure Test of Elderly After Hip Fracture in Serbia

Acta Médica Portuguesa ◽

10.20344/amp.4267 ◽

2014 ◽

Vol 27 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Natasa Radosavljevic ◽

Dejan Nikolic ◽

Milica Lazovic ◽

Zoran Radosavljevic ◽

Aleksandar Jeremic

Keyword(s):

Hip Fracture ◽

Functional Recovery ◽

Age Groups ◽

Functional Independence Measure ◽

Severity Index ◽

Functional Independence ◽

Post Discharge ◽

Third Age ◽

Period 2 ◽

Group 2

Introduction: The aim of the study was to evaluate motor functional status measured by motor Functional Independence Measure (mFIM) test in population above 65 years of age after the hip fracture. Material and Methods: We evaluated 203 patients after hip fracture by mFIM test on 3 occasions: at admission (Period-1), at discharge (Period-2) and 3 months after discharge (Period-3); 3 age groups: Group65-74, Group75-84 and Group85-up and 2 groups concerning Severity Index (SI): group 0-1.99 (SI1) and group ≥ 2 (SI2). Results: In same SI group there is significant increase in mFIM values for Period-2 and Period-3 for both genders and in first two age groups, while for those above 85 years of age with higher SI we found non-significant change in mFIM values between discharge and 3 months post discharge period. Discussion: The most significant improvement is obtained for women in first and third age groups and with higher SI. Conclusion: Gender is not significant predictor for motor functional recovery measured by mFIM test in patients with hip fracture, although the admittance mFIM is a good indicator for mFIM capacity recovery in women of certain age groups (first and third age groups).

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Impact of Length of Stay on Functional Outcomes of TBI Patients

The American Surgeon ◽

10.1177/000313480507101105 ◽

2005 ◽

Vol 71 (11) ◽

pp. 920-930 ◽

Cited By ~ 5

Author(s):

M.L. Hawkins ◽

F.D. Lewis ◽

R.S. Medeiros

Keyword(s):

Length Of Stay ◽

Functional Outcomes ◽

Inpatient Care ◽

Average Length ◽

Functional Independence ◽

Average Length Of Stay ◽

Group 2 ◽

The Impact ◽

Group 1

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient

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Potential Predictors of Motor and Functional Outcomes After Distributed Constraint-Induced Therapy for Patients With Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308321773 ◽

2008 ◽

Vol 23 (4) ◽

pp. 336-342 ◽

Cited By ~ 32

Author(s):

Keh-chung Lin ◽

Yan-hua Huang ◽

Yu-wei Hsieh ◽

Ching-yi Wu

Keyword(s):

Upper Extremity ◽

Distal Part ◽

Functional Performance ◽

Functional Independence Measure ◽

Functional Independence ◽

Motor Ability ◽

Motor Pathways ◽

Movement Performance ◽

Quality Of Movement ◽

Motor Outcomes

Background. Selection of patients who are most and least likely to benefit from constraint-induced therapy (CIT) for the upper extremity is uncertain. Objective. This study investigated demographic and clinical characteristics that may predict outcomes for a distributed form of CIT. Methods. A group of 57 patients were treated with distributed CIT, and 7 potential predictors were identified, including age, sex, side of stroke, time since stroke, spasticity, neurologic status, and movement performance of the distal part of the upper extremity. Treatment outcome was assessed in terms of motor performance, perceived functional ability of the affected hand, and functional performance of daily activities, measured by Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and Functional Independence Measure (FIM), respectively. Results. Motor ability of the distal part of the upper extremity and time since stroke were significantly predictive of outcomes on the FMA (adjusted R2 = 0.18, P = .002) and the MAL subtest quality of movement (adjusted R 2 = 0.43, P < .0001). Motor ability and age were significant predictors of amount of use measured by the MAL (adjusted R2 = 0.20, P = .001). None of the variables exhibited a predictive relationship with the FIM. Conclusions. The best predictor for motor outcomes after distributed CIT was greater motor ability of the distal part of the upper extremity, which is consistent with the presence of residual motor pathways that may respond to training. The FMA may be of value in stratifying patients for their likelihood to benefit from distributed CIT protocols.

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Multidisciplinary versus physiotherapy-only weekend rehabilitation: A prospective cohort study

10.21203/rs.3.rs-428190/v1 ◽

2021 ◽

Author(s):

Erin Caruana ◽

David Rowell ◽

Suzanne Kuys ◽

Sandra G. Brauer

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Prospective Cohort ◽

Functional Independence Measure ◽

Cost Savings ◽

Functional Independence ◽

Historical Control Group ◽

Historical Control ◽

Control Group ◽

Rehabilitation Unit

Abstract Background This study aims to investigate the impact of multidisciplinary Saturday rehabilitation (MSR) on length of stay, functional independence, gait and balance when compared to a 6-day physiotherapy-only service in a pragmatic setting. An economic evaluation of the intervention conducted from the perspective of the healthcare provider is included.Methods A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit to compare a multidisciplinary and physiotherapy-only 6-day rehabilitation service. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.Results A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (MSR) had 192 participants and the historical control group (physiotherapy Saturday rehabilitation) had 174 participants). Participants in the historical control group had lower total and cognitive Functional Independence Measure scores (p < 0.078), and generally performed at a lower level on admission gait and balance measures compared to the prospective cohort. More participants in the prospective cohort attended weekend therapy, attending more sessions and spending more time in therapy compared to those in the historical control group (p < 0.012). After controlling for differences in admission Functional Independence Measure scores, length of stay was reduced by 1.39 ± 0.77 days. The economic evaluation estimated cost savings of $1,536 per patient. The largest savings were attributed to neurological patients $4,854. Traumatic and elective orthopaedic patients realised cost savings per admission of $2,668 and $2,180, respectively.Conclusions Implementation of MSR results in a more efficient service, enabling a greater amount of therapy to be provided over a shorter length of stay. The provision of a multi-disciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.Trial registration not applicable.

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The Use of the Functional Independence Measure to Determine Outcomes of Upper Extremity Reconstruction in Tetraplegia

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(09)60134-9 ◽

2009 ◽

Vol 34 (7) ◽

pp. 47-48

Author(s):

Dora Rendulic ◽

Mary Ann O'Dell ◽

Michelle A. James

Keyword(s):

Upper Extremity ◽

Functional Independence Measure ◽

Functional Independence ◽

Extremity Reconstruction

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Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial

BioMed Research International ◽

10.1155/2014/752128 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 45

Author(s):

Paweł Kiper ◽

Michela Agostini ◽

Carlos Luque-Moreno ◽

Paolo Tonin ◽

Andrea Turolla

Keyword(s):

Randomized Controlled Trial ◽

Virtual Environment ◽

Upper Extremity ◽

Motor Function ◽

Upper Limb ◽

Controlled Trial ◽

Functional Independence Measure ◽

Functional Independence ◽

Stroke Etiology ◽

Randomized Controlled

Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic).Design. Randomized controlled trial.Participants. Forty-four patients affected by stroke.Intervention. The patients were randomized into two groups: RFVE (N=23) and TR (N=21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks.Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak).Results. The F-M UE (P=0.030), FIM (P=0.021), time (P=0.008), and peak (P=0.018), were significantly higher in the RFVE group after treatment, but not speed (P=0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P=0.031), time (P=0.011), and peak (P=0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P=0.005) when treated by RFVE.Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered withNCT01955291.

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Influence of Physical Therapy and Cholinergic Medication on the Life Quality Parameters in Post-Stroke with the arm Motor Dysfunction

Archive of Clinical Medicine ◽

10.21802/acm.2021.1.2 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Iriah Festus Uwa-Agbonikhena

Keyword(s):

Quality Of Life ◽

Physical Therapy ◽

Functional Independence ◽

Motor Dysfunction ◽

Stroke Patients ◽

Post Stroke ◽

Group 3 ◽

Group 2 ◽

Group 1

Motor dysfunction makes the greatest contribution to the patient’s functional independence and has a significant impact on the quality of life (QOL) of post-stroke patients. The objective of the research was to evaluate the impact of different physical therapy approaches and choline alphoscerate on the functional independence and quality of life in patients in 1 year after ischemic stroke. Materials and methods. There were 104 patients examined in 1-year period after first anterior circulation ischemic stroke. Neurological status, functional independence and QOL were assessed according to the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Functional Independence Measurement (FIM) and Stroke Specific Quality of Life Scale (SS-QOL). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for hand motility improvement for 2 months; patients in Group 3 received choline alphoscerate 400 mg twice a day for 2 months in addition to the abovementioned physical therapy. Results. 2 months of physical therapy in Group 1 resulted in increase of “Transfer” and subtotal motor scores. A significant increase in the “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in the patients in Group 2 and Group 3; the motor subtotal and total scores in Group 3 were 11.4% and 11.6 % higher than the same indices in Group 1, respectively. The most significant improvement of QOL parameters was observed in patients in Group 3, whose total score increased by 36.8% from the baseline (p<0.05), and exceeded the same index of Group 1 by 17.1% (p<0.05). Conclusions. Adding of hand exercise into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore functional independence. Stimulation of cholinergic neurotransmission with the choline alphoscerate may also increase the efficacy of physical therapy and contribute to patients’ general mobility, upper extremity function and QOL.

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Monitoring Dysfunction after Stroke Sequelae in Patients undergoing Hydro-/ Thermo-/ Kinesio-Therapy

ARS Medica Tomitana ◽

10.2478/arsm-2020-0014 ◽

2020 ◽

Vol 26 (2) ◽

pp. 70-75

Author(s):

Albadi Irina ◽

Ciobotaru Camelia ◽

Ionescu Elena Valentina ◽

Oprea Doinita ◽

Geanta Cristina Ioana ◽

...

Keyword(s):

Functional Independence Measure ◽

Functional Independence ◽

Daily Basis ◽

Functional Deficit ◽

Physical Kinetic ◽

Important Health ◽

Recovery Treatment ◽

Self Service ◽

Group 2

Abstract Stroke is an important health problem generating a set of musculoskeletal and cognitive consequences that significantly affect the patient’s clinical-functional status and quality of life, as well as the effectiveness of the recovery treatment. Hydro-/ thermo-/ kinesio-therapy with water from Lake Techirghiol, known for its special properties, is also used for patients with neurological disorders and consists in immersing the patient in the therapeutic pool with specific exercises under the strict supervision of specialized medical staff. The aim of this study is to analyze the effects of Lake Techirghiol water on the functional deficit in patients with post-stroke sequelae. In this sense, 200 patients who were hospitalized in the Balneal Rehabilitation Sanatorium of Techirghiol, Constanta County, Romania during 2018-2020 were included in the study and they were divided into two groups: patients from group 1 performed on a daily basis, for 12 days, hydro-/ thermo-/ kinesiotherapy and other physical-kinetic procedures, and the patients from group 2 performed on a daily basis, for 12 days, only physical-kinetic procedures, without hydro-/ thermo-/ kinesio-therapy. Patients’ assessment was made based on the Functional Independence Measure scale and a better evolution was observed in the patients who performed hydro-/ thermo-/ kinesio-therapy as compared to those who did not perform this procedure, in the sense of a diminution of the functional deficit by making self-service activities easier and by improving gait disorders and transfers. We consider appropriate that we extend the period of patients’ treatment and follow-up in our next research so as to highlight, if relevant, any notable changes in terms of increasing functional independence also in the case of patients undergoing land-based kinesiotherapy.

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Can the Wolf Motor Function Test be Streamlined?

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308331141 ◽

2009 ◽

Vol 23 (5) ◽

pp. 422-428 ◽

Cited By ~ 31

Author(s):

Kimberly Bogard ◽

Steven Wolf ◽

Qin Zhang ◽

Paul Thompson ◽

David Morris ◽

...

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Movement Therapy ◽

Change Score ◽

Functional Level ◽

Regression Methods ◽

Constraint Induced Movement Therapy ◽

Gender Concordance ◽

Function Test ◽

Wolf Motor Function Test

Background. To assess upper extremity (UE) capabilities following stroke, the Wolf Motor Function Test (WMFT) measures time to complete 15 UE tasks and 2 strength tasks, but takes 30 to 45 minutes for the clinician to complete. Objective. In an effort to streamline the WMFT, this study evaluated the association between the magnitude of improvement on any timed task of the WMFT and the change score on all other tasks among participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial. Methods. This association was evaluated using regression methods according to chronicity and controlling for key covariates (functional level, gender, concordance) for log mean WMFT scores. Results. After controlling for covariates, 6 tasks (hand to table [front], hand to box [front], reach and retrieve, lift can, lift pencil, and fold towel) influenced the overall WMFT score for survivors meeting EXCITE criteria and treated within 3 to 9 months poststroke. Six different tasks (extend elbow weight, hand to box [front], lift can, lift pencil, turn key in lock, and fold towel) influenced the overall WMFT score for those receiving constraint-induced movement therapy (CIMT) 1 year later. The importance of certain tasks relative to others may best represent overall UE function, but this streamlining enables the clinician to prioritize these tasks in the evaluation. Conclusions. The delineation of those tasks depends on the time poststroke from enrollment to CIMT. This study demonstrates that the WMFT can be streamlined from 17 to 6 tasks.

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