Objective: To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation. Design: A pilot randomized crossover trial. Setting: Two rehabilitation hospitals. Subjects: Twenty-two patients with subacute stroke. Interventions: Participants were randomly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation. The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week, followed by another week with task-oriented training alone. The delayed group underwent the same training in reverse order. Main measures: Outcome measures were the level of fatigue and Wolf Motor Function Test. Patients were assessed at baseline, one and two weeks. Results: All participants completed the study with no adverse events. There was no significant difference in level of fatigue between each treatment. From baseline to one week, the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test (decrease in mean time (± SD) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds, respectively) but the difference did not reach significance after Bonferroni correction ( P = 0.041). Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group ( P < 0.01). Conclusion: Peripheral sensory nerve stimulation is feasible in clinical settings and may enhance the effects of task-oriented training in patients with subacute stroke.
Purpose] To investigate the effect of action observation therapy on the lower limb function of chronic stage hemiplegic stroke patients.[Subjects] The subjects were 21 chronic stage hemiplegic stroke patients.[Methods] The subjects were divided into an action observation therapy (AO) group, and a control group. The AO group watched a video of a person performing forward and lateral stepping for 5 min, then performed the same exercise themselves for 5 min. The control group performed only the forward and lateral stepping for 5 min. The outcome measures, the numbers of successful forward and lateral steps, the functional reach test (FRT), and the four square step test (FSST), were measured before, after, and 1 month after the intervention. [Result] In the comparison of the groups, mutual interaction was found for FRT. In the AO group, the successful number of forward steps, FRT, and FSST results showed significant improvements, which were maintained at 1 month post-intervention. Regarding the effective dose, all of the measured items of the AO group were better than those of the control group.[Conclusion] Action observation therapy for chronic stage hemiplegic stroke patients significantly improved lower limb performance in comparison with physical training alone.
[Purpose] This study aimed to verify the appropriate number of measurements and the intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD) for geriatric and stroke patients. [Subjects and Methods] The subjects were 40 inpatients, who were divided into two groups: 20 stroke patients in the stroke group (SG), and 20 geriatric patients in the no-stroke group (N-SG). Measurements were performed three times using an HHD with a belt. The reliability was verified using Bland-Altman analysis and the intraclass correlation coefficient (ICC). [Results] ICC (1, 1) was >0.9. A systematic bias was not observed between the first and second measurement values except for the right side in N-SG. A systematic bias between the maximum value obtained during the first and second measurements and third measurement value was observed on the left side in N-SG, and on the non-paralyzed side in SG: the third measurement values were small in both cases. [Conclusion] Intrarater reliabilities were high for shoulder horizontal adductor strength measurements using an HHD with a belt for geriatric and stroke patients. Taking the systematic bias into consideration, these findings suggest that the required number of measurements is two.
[Purpose] The effectiveness of training to control standing postures at gradually adjusted difficulty levels for acute post-stroke hemiplegic patients with Pusher syndrome symptoms was compared. [Subjects and Methods] Ten post-stroke hemiplegic patients with Pusher syndrome symptoms admitted to an acute care ward were studied. Higher brain dysfunction was present in all cases. All patients were provided with training to control standing postures at 10 gradually adjusted difficulty levels. These levels, the contents of support (assistance, verbal instructions + tapping, observation), and 3 options (triangular bandage, ankle foot orthosis, knee immobilizer) were quantified as scores from 0 to 148. [Results] Improvements were observed in all cases from the initial training day. In 6 to 26 days, the patients advanced to Levels 4 to 8. During this period, there was no change in their physical functions, such as motor function.
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