Upper limb arm and hand home-based exercise training for people after stroke in the UK

New research in the UK will be conducted on administering Physiotherapy at home after stroke. Neuro physical therapists from Bristol, Birmingham and Newcastle will recruit patients with upper-limb motor impairment including shoulder  and hand movement deficits after discharge from hospital post-stroke. The stroke patients will be up to 12 months post stroke. The primary outcome measures for assessment of arm function will be the Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT). The secondary measures will be the Motor Activity Log, Stroke Impact Scale, Carer Strain Index, and health and social care resource use.

Improving functional ability in stroke patients by improving movement impairments

Do improvements in a specific task used in massed practice therapy transfer to untrained tasks. This question was answered by Schaefer SY et al. from Washington University School of Medicine, St Louis, MO, USA in Neurorehabilitation and Neural Repair, 04/24/2013. The team aimed at showing that task-specific training is a viable approach for recovering motor function after stroke and also to help design task–specific training plans to maximize therapy benefits. The group found that for stroke patients with chronic mild to moderate hemiparesis the improvements in impairments achieved during task practice did transfer to untrained upper-extremity motor tasks e.g washing, feeding and dressing.

 

Intensive physical and occupational therapy improves the functional ability of the arm and hand in chronic stroke

Intensive physiotherapy and occupational therapy in the rehabilitation center and at home improves functional ability in chronic stroke. Published in Restorative Neurology and Neuroscience, 04/11/2013 de Diego C et al from physiotherapy and Occupational Therapy Neurological Center of Sant Cugat del Valles, Spain show that following 8 weeks of daily physical and occupational therapy improved the functional outcome of the upper limb in chronic hemiparesis stroke patients. The training consisted of functional activity training, tactile stimulation, mental imagery and practice of ADL and impairment training at home. The outcome measures used include the Fugl Meyer Assessment (FMA), Motor Activity Log (MAL) and Stroke Impact Scale-16 (SIS-16) scores.

 

Feasibility of Somatosensory Stimulation at home in chronic stroke patients

Writing in Neurorehabilitation and Neural Repair, 04/01/2013, Dr. dos Santos–Fontes RL et al from University of São Paulo, São Paulo, Brazil look at the benefits of Home-Based Nerve Stimulation to Enhance Effects of Motor Training in Patients in the Chronic Phase After Stroke.

The group measure the improvements in paretic arm performance in the chronic phase after stroke to show that Somatosensory stimulation and repetitive  peripheral nerve sensory stimulation improve motor function of the upper limb in home therapy of chronic stroke.

Postural control and functional ability in Spinal Cord Injury – SCI

Published in Archives of Physical Medicine and Rehabilitation, 03/13/2013  Dr. Shin S et al from Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign USA compare seated postural control in Spinal cord injury and control patients.

Seated posture and trunk control, are important factors affecting upper, extremity function in wheelchair users. Stability of  pelvis and trunk are required in order to provide a basis for upper extremity movement. Additionally, the ability to move the trunk and pelvis increases  functional ranges of motion. Therefore following SCI the ability to stabilize the trunk and pelvis and have adequate trunk mobility has important functional consequences.

The above group looked at the validity of outcome measures to evaluate postural control.

Upper limb Paresis after Stroke

Writing in Journal of the American Medical Directors Association, 03/05/2013 Dr. Timmermans from Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands quotes that More than 50% of patients with upper limb paresis after stroke face long-term impaired arm function and ensuing disability in daily life.

The HandTutor and the ArmTutor is used by outpatients and home patients to improve functional upper limb movement ability.

Mirror Therapy (MT) movement performance and motor control

Published in Archives of Physical Medicine and Rehabilitation, 02/25/2013, Dr. Wu and team from Department of Occupational Therapy Chang Gung University, Taoyuan, Taiwan look at the Effects of Mirror Therapy on Motor and Sensory Recovery in Chronic Stroke. The group compare the outcomes of movement performance, motor control, sensory recovery, and performance of activities of daily living using Fugl-Meyer Assessment (FMA), MAL and ABILHAND measures of daily hand use. Chronic stroke patients with mild to moderate motor impairment were treated at an intensity of 1.5 hours/day, 5 days/week, for 4 weeks with task-oriented upper extremity training and Mirror therapy.  The occupational therapists concluded that MT after stroke might result in beneficial effects on movement performance and motor control.

Movement impairment after cervical spinal cord injuries (SCI).

Writing in Neurol Sci. (neurological sciences) 2013 Feb Dr. Figueiredo N and team from Medical School, Federal University of Mato Grosso, UFMT, Brazil discuss nomenclature used to describe motor impairments caused by cervical spinal cord injuries (SCI).

Patients presenting lower cervical SCI with total loss of the motor voluntary movements of their lower trunk and inferior limbs (lower extremtiy) and partial upper limb (upper extremtiy) movement impairment with varied movement ability of the proximal upper limb can be described using a number of terms including tetraplegia, quadriplegia, quadriparesis, tetraparesis, or incomplete quadriplegia or incomplete tetraplegia. The authors however recommend that the movement impairment is better described as paraplegia with brachial diparesis or brachila Diplegia. Paraplegia as the movement impairment is present on both sides the body and the arm movement impairment being described as brachial – the principal nerves of the shoulder and upper limb and diplegia – affecting both sides of the body to the same level.

 

Improving post stroke upper limb dysfunction will improve quality of life

Published in Disability & Rehabilitation Dr. Morris and colleagues from the University of Dundee, Dundee, UK look at the health related quality of life (HRQOL) of stroke patients 6 months after the event. His paper discusses how upper limb/ extremity impairment affects patient perceived (HRQOL). The group conclude that management strategies including physiotherapy and occupational therapy that facilitate UL recovery and improve activities of daily living will benefit patient quality of life.

The HandTutor, ArmTutor and 3DTutor is used to improve shoulder, elbow, wrist and fine finger movement ability post stroke.

 

 

Post stroke treatment with botulinum toxin improves upper-extremity function

Writing in Archives of Physical Medicine Rehabilitation Dr. Foley and his team discuss that evidence from the literature shows that botulinum toxin type A (BTX-A) is associated with improvements in activity capacity or performance associated with poststroke spasticity in the upper extremity. Dr Foley and his team of physical and occupational therapists work at the Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital London, Ontario, Canada.