Compelled Body Weight Shift Approach in Rehabilitation of Individuals With Chronic Stroke.
Compelled body weight shift approach in rehabilitation of individuals with chronic stroke.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 556-63
Aruin AS, Rao N, Sharma A, Chaudhuri G
Purpose: This study was designed to evaluate the effectiveness of the compelled body weight shift (CBWS) therapy approach in the rehabilitation of individuals with chronic stroke. CBWS involves a forced shift of body weight toward a person’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity. Method: Eighteen individuals with chronic, unilateral stroke (mean age 57.7 ± 11.9 years, with a range of 35-75 years; mean time since stroke 6.7 ± 3.9 years, with a range of 1.1-14.1 years) who showed asymmetrical stance were randomly divided into 2 groups: the experimental group received 6 weeks of physical therapy combined with CBWS therapy, and the control group received only physical therapy. Both groups underwent a battery of identical tests (Fugl-Meyer Assessment, Berg Balance Scale, weight bearing, and gait velocity) before the start of the rehabilitation intervention, following its completion, and 3 months after the end of therapy. Results: After the intervention, weight bearing on the affected side (measured with the Balance Master) increased in the experimental group to a larger degree compared to the control group (9.7% vs 6.4%). Similarly, gait velocity increased 10.5% in the experimental group compared to the control group. Improvements in weight bearing and gait velocity were maintained in the experimental group after the 3-month retention period. Conclusion: The study outcome revealed that a 6-week intervention involving CBWS therapy could result in a long-lasting improvement of the symmetry of weight bearing and velocity of gait in individuals with chronic stroke.
HubMed – rehab
Relation between the upper extremity synergistic movement components and its implication for motor recovery in poststroke hemiparesis.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 545-55
Pandian S, Arya KN
Background: Synergy is a functional linkage of muscles during voluntary motor action. In poststroke hemiparesis, synergistic movements get disorganized in the form of stereotyped behaviors. Furthermore, there is a linkage between the movement components of the synergies, which should be understood for focused motor rehabilitation. Objective: To find the relationship between the synergistic motor behavior and recovery of the individual movement in chronic poststroke hemiparetic subjects. Method: A prospective, cross-sectional, observational study was conducted at an outpatient occupational therapy unit of a rehabilitation institute. A convenience sample of 30 chronic poststroke hemiparetic subjects (25 male and 5 female; 16 left sided and 14 right sided) was assessed using the Fugl-Meyer assessment (FMA) and Brunnstrom recovery stages of arm (BRS-A) and hand (BRS-H). Results: The mean poststroke duration of the subjects was 40.9 months. There were significantly higher scores ( P < .001) for BRS-A (4.13 ± 1.07) and FMA upper arm (29.03 ± 4.31) as compared to BRS-H (2.47 ± 1.45) and FMA wrist and hand (11.50 ± 5.88), respectively. Very high correlation ( r = 0.9 to 1.0; P < .05) was found between the 2 components of FMA (wrist circumduction and spherical grasp). Moderate ( r = 0.5 to 0.69; P < .05) to high ( r = 0.7 to 0.89; P < .05) correlation was found between many components of FMA (flexor synergy, extensor synergy, movement combining synergies, movement out of synergy, upper arm, and wrist-hand components). Conclusion: Many upper extremity movement components of the paretic side were related to one another. The components may be used for motor rehabilitation in order of their strength of association. The concept of synergistic linkage may be applied for motor training of the upper limb at a particular stage of the recovery. HubMed – rehab
Effectiveness of psychological interventions in chronic stage of stroke: a systematic review.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 536-44
Mehta S, Pereira S, Janzen S, McIntyre A, McClure A, Teasell RW
Objective: To examine the effectiveness of interventions for psychological issues faced by individuals post stroke when initiated in the chronic stage of stroke. Method: MEDLINE, CINAHL, EMBASE, and Scopus databases were searched from 1980 to July 2012. A study was included if (1) the study was a randomized controlled trial (RCT); (2) at least 50% of individuals in the study were entered into the study at over 6 months post stroke; (3) the study examined the effect of an intervention on psychological functioning; and (4) study participants were ? 18 years of age. Similar interventions were grouped and results summarized. Data on the study design, participant characteristics, interventions, outcomes, and adverse events were extracted from each of the selected studies. Results: Nine RCTs met inclusion criteria. All 9 studies examined effectiveness on mood and 3 on adjustment. Repetitive transcranial magnetic stimulation had the strongest evidence of effectiveness in improving mood followed by pharmacotherapy; whereas exercise appeared to be effective in improving adjustment and coping among individuals in the chronic stage of stroke. Conclusion: Overall, interventions provided in the chronic stage of stroke appear to be effective in improving mood and adjustment up to 3 months post intervention. The use of multidisciplinary interventions and acceptance models may be important in the overall adjustment process.
HubMed – rehab
Therapeutic interventions for aphasia initiated more than six months post stroke: a review of the evidence.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 523-35
Allen L, Mehta S, McClure JA, Teasell R
Background: Aphasia effects up to 38% of acute stroke patients. For many of these individuals, this condition persists far beyond the acute phase. The purpose of this review is to evaluate the effectiveness of therapeutic interventions for aphasia initiated more than 6 months post stroke. Methods: A literature search was conducted for articles in which aphasia treatments were initiated more than 6 months post stroke. Searches were conducted in multiple databases including MEDLINE, Scopus, CINAHL, and EMBASE. Results: A total of 21 randomized controlled trials (RCTs) met the inclusion criteria. There is good evidence to suggest that the use of computer-based treatments, constraint-induced therapy, intensity of therapy, group language therapies, and training conversation/communication partners are effective treatments for chronic aphasia. Repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and the use of the drugs piracetam, donepezil, memantime, and galantamine have also demonstrated evidence that they are effective treatments of aphasia 6 months or more post stroke onset. Neither filmed language instruction nor the drug bromocriptine has been shown to be effective in treating chronic aphasia. Conclusions: There is evidence to support the use of a number of treatments for chronic aphasia post stroke. Further research is required to fully support the use of these interventions and to explore the effectiveness of other aphasia interventions in the chronic stage.
HubMed – rehab
Evidence for therapeutic interventions for hemiplegic shoulder pain during the chronic stage of stroke: a review.
Filed under: Rehab Centers
Top Stroke Rehabil. 2012 Nov-Dec; 19(6): 514-22
Viana R, Pereira S, Mehta S, Miller T, Teasell R
Objective: To determine the effectiveness of therapeutic interventions targeting hemiplegic shoulder pain (HSP) more than 6 months post stroke. Methods: A literature search of multiple databases (PubMed, CINAHL, Ovid, and EMBASE) was conducted to identify articles published in the English language from 1980 to April 2012. Studies were included if (1) all participants were adults who had sustained a stroke; (2) research design was a randomized controlled trial (RCT) that examined the effectiveness of any treatment for HSP; (3) all participants had experienced stroke at least 6 months previously; and (4) an assessment of pain had been conducted before and after treatment using a standardized method. The following data were extracted: patient characteristics (ie, age, gender, time since stroke), sample size, study design, measurement of pain pre and post treatment, and adverse events. Results: Ten RCTs (PEDro scores 4-9) met inclusion criteria and included a total sample size of 388 individuals with a mean age of 53.2 years (range, 43.6-73.2). Mean time post stroke was 18.4 months. Three studies addressed the use of botulinum toxin type A (BTx-A); 2 studies examined electrical stimulation; 3 studies focused on intraarticular glenohumeral corticosteroid injections; 1 studied subacromial corticosteroid injections; and 1 study looked at massage therapy. Conclusions: Positive outcomes were noted with the use of corticosteroid injections and electrical stimulation and conflicting results were seen regarding the use of BTx-A. Overall, these targeted therapies provide benefit in the treatment of HSP in individuals who are more than 6 months post stroke.
HubMed – rehab
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