Sinikka Peurala - Academia.edu (original) (raw)
Papers by Sinikka Peurala
Kuopion yliopisto, Jun 15, 2005
Functional outcome of stroke patients depends on various factors such as rapid access to the emer... more Functional outcome of stroke patients depends on various factors such as rapid access to the emergency ward, care in the stroke unit and level of the rehabilitation. Stroke, infarction or intracerebral hemorrhage may cause motor weakness, sensory and proprioceptive deficits, intellectual impairment, emotional distress and motivational and social problems. Although most stroke patients regain walking independence, many have continuing problems with mobility due to impaired balance, motor weakness, and decreased walking velocity. The main purpose of this study was to evaluate gait rehabilitation in patients over six months poststroke. First, the amount and content of the exercise of a tailored three-week gait-oriented physiotherapy program was analysed in an in-patient rehabilitation setting. Subsequently, the postural control, the spatio-temporal gait characteristics and the effects of the gait-oriented rehabilitation were analysed. Static balance was assessed with the emphasis on differentiating the left and right hemiparesis. The gait-oriented rehabilitation was compared with conventional rehabilitation. Additionally, three gait-oriented rehabilitation strategies were compared: the bodyweight supported (BWS) gait trainer exercise with functional electrical stimulation (FES), the BWS gait trainer exercise without FES and active walking exercise. The study population consisted of 59 patients with chronic stroke and 30 healthy subjects. Their motor abilities were studied with a battery of measurements and the details of the therapy were recorded. Comparison of three gait-oriented rehabilitation strategies revealed no differences between groups in motor improvements. Gait improved 14-24 % after 28 hours of instructed physiotherapy and self-initiated training in the gait-oriented groups and their dynamic balance improved by 28-48 %. The patients seemed to depend on a larger postural sway than healthy subjects to maintain their static balance and there may be specific features due to the side of the hemiparesis. Gait-oriented rehabilitation improved certain spatiotemporal gait characteristics not seen in less intensive conventional rehabilitation. All gaitoriented strategies were good choices for ambulatory stroke patients. The follow-up of six months showed no decline in gains in gait. The same time frame in the gait trainer allowed more repetitions of steps and a longer walking distance. Intensive training improved gait in patients with chronic stroke and may lead to increased options for daily activities.
Liiteluettelo Liite 1. RBDI-testilomake. Liite 2. SOC-13-testilomake. Liite 3. WMF T-testilomake.... more Liiteluettelo Liite 1. RBDI-testilomake. Liite 2. SOC-13-testilomake. Liite 3. WMF T-testilomake. Liite 4. Pinch-testilomake. Liite 5. Kävelyn kuntoutuksen kotikäyntilomake. Liite 6. Käden tehostetun käytön kuntoutuksen kotikäyntilomake. Liite 7. Ar viointimenetelmäkäsit teiden jakautuminen ICF-luokituksen pääluokkiin (1. luokitusporras) luokituksen eri osa-alueilla. Liite 8. Kävelyn kuntoutuksen perusjakson kyselylomake. Liite 9. Käden tehostetun käytön kuntoutuksen perusjakson kyselylomake. Liite 10. Kävelyn kuntoutuksen seurantajakson I kyselylomake. Liite 11. Käden tehostetun käytön kuntoutuksen seurantajakson I kyselylomake. Liite 12. Alkukyselylomake. Liite 13. Seurantakysely I (6 kk). Liite 14. Seurantakysely II (12 kk). Liitteet ovat tämän julkaisun sähköisen version yhteydessä.
AbstractObjective: To examine the effect of constraint-induced movement therapy and modified cons... more AbstractObjective: To examine the effect of constraint-induced movement therapy and modified constraint-induced movement therapy on activity and participation of patients with stroke (i.e. the effect of differenttreatment durations and frequency) by reviewing the results of randomized controlled trials.Data sources: A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, PEDro,OTSeeker, CENTRAL and by manual search.Reviewmethods:Randomizedcontrolledtrialsforpatientsover18yearsoldwithstrokeandpublishedinFinnish,Swedish,EnglishorGermanwereincluded.StudieswerecollecteduptothefirstweekinMay2011.The evidence was high, moderate, low or no evidence according to the quality of randomized controlledtrial and the results of meta-analyses.Results: Search resulted in 30 papers reporting constraint-induced movement therapy, including 27 ran-domized controlled trials published between 2001 and 2011. Constraint-induced movement therapy prac-tice for 60–72 hours over two weeks prod...
Käden pakotetun käytön ohjelma on uusi kuntoutusmenetelmä. Tämän tutkimuksen tarkoitus on ollut t... more Käden pakotetun käytön ohjelma on uusi kuntoutusmenetelmä. Tämän tutkimuksen tarkoitus on ollut tutkia menetelmän tehokkuutta kroonisilla aivohalvauspotilailla, joille on jäänyt yläraajaan käden normaalin käytön pysyvästi estävä vamma. Kuntoutusohjelmassa potilaan koko huomio ja ponnistukset kohdennetaan vammautuneeseen yläraajaan. Kättä harjoitetaan monipuolisesti ennalta suunnitelluin ohjatuin harjoituksin kokopäivätoimisesti kahden viikon ajan. Tutkimukseen hyväksyttiin 33 potilasta, joille tehtiin harjoitusjaksoa edeltävä alkutesti ja jakson jälkeen lopputesti. Käden toimintakyky parani heillä merkitsevästi. Potilaista 16 osallistui perustason mittaukseen kaksi viikkoa ennen harjoitusohjelmaa ja seurantatestaukseen kolme kuukautta hoitojakson päättymisen jälkeen. Kahden viikon harjoittelujakson jälkeen tehtävistä suoriutuminen nopeutui siten, että testin suorittamiseen kulunut aika puolittui. Myös toimintakyky parani yleensä merkitsevästi, samoin kuin liikesuorituksen laadukkuus...
320 s. + 69 sähköistä liitettä Laki Kelan kuntoutuksesta määrittää, että kuntoutuksen tulee olla ... more 320 s. + 69 sähköistä liitettä Laki Kelan kuntoutuksesta määrittää, että kuntoutuksen tulee olla hyvän kuntoutuskäytännön mukaista. Tämän Vaikeavammaisten kuntoutuksen kehittämishankkeeseen (VAKE) kuuluvan tutkimuksen tavoitteena oli kolmen diagnoosiryhmän – aivoverenkiertohäiriön (AVH), multippeliskleroosin (MS) ja Cerebral Palsyn (CP) – avulla kuvata Kelan järjestämän vaikeavammaisten lääkinnällisen kuntoutuksen nykytilaa, sen kehittämistarpeita ja eri kuntoutustoimenpiteiden vaikuttavuutta sekä laatia suositukset hyvästä kuntoutuskäytännöstä. Tutkimus toteutettiin laajassa tutkimusyhteistyössä vuosina 2007–2009. Kirjan toisessa osassa kuvataan AVH-, MS- ja CP-kuntoutuksen nykykäytännöt, jotka perustuvat kuntoutusalan ammattilaisille ja asiantuntijoille tehtyihin kysely- ja haastattelututkimuksiin, sekä esitellään Kelalle lähetettyjen kuntoutussuunnitelmien analyysit. Kirjan kolmas osa käsittelee kuntoutuksen arviointikäytäntöjä. Tulokset perustuvat nykykäytäntöjä selvittäneisiin ...
The ICF (International Classification of Functioning, Disability and Health) was translated to Fi... more The ICF (International Classification of Functioning, Disability and Health) was translated to Finnish in 2004. However, lack of systematic education, clinical networks, a Finnish electronic version, and practical tools has prevented its widespread utilization in clinical practice. Networks can encourage partnerships in research, development and implementation activities. The National Institute for Health and Welfare (THL) initiated a learning network on the ICF issues in “Innovillage” during autumn 2012. This paper describes the objectives, connections and the initiated activities of the ICF learning network in Finland. The ICF learning network is open for all interested in learning, education, development and research considering the ICF. It aims to identify challenges, develop, evaluate and disseminate the ICF-based practices by organizing workshops on the ICF-related topics. The network utilizes the developed virtual tools and services in “Innovillage” (joint workspace, project ...
Restorative neurology and neuroscience, 2007
It is known that visuospatial orientation and the extent of spontaneous recovery vary between rig... more It is known that visuospatial orientation and the extent of spontaneous recovery vary between right or left hemisphere affected stroke patients. We hypothesized that the right hemisphere affected chronic patients would show more impaired static balance than left hemisphere affected patients. The purpose of the study was to assess displacement of the center of pressure (COP) of ambulatory patients with either left or right hemiparesis. Forty-five patients and thirty healthy subjects participated and static balance was measured while standing on a force plate. The patients showed more than four times higher mean velocity moment and two times faster anterior-posterior (AP) and medial-lateral (ML) speed of COP displacement than healthy subjects. The patients with left hemiparesis, and affected right hemisphere, had higher power peak magnitudes of COP displacements than patients with right hemiparesis both in ML and AP directions at low frequencies. The patients had higher power peak mag...
Restorative neurology and neuroscience, 2005
To assess the effects of rehabilitation in thirty-seven ambulatory patients with chronic stroke d... more To assess the effects of rehabilitation in thirty-seven ambulatory patients with chronic stroke during three weeks in-patient rehabilitation period. In the intervention group, each patient received 75 min physiotherapy daily every workday including 20 minutes in the electromechanical gait trainer with body-weight support (BWS). In the control group, each patient participated in 45 min conventional physiotherapy daily. Motor ability was assessed with the first five items of the Modified Motor Assessment Scale (MMAS1-5) and ten meters walking speed. Spatio-temporal gait characteristics were recorded with an electrical walkway. The MMAS1-5 (p<0.0005 and p=0.005) and ten meters walking time (p<0.0005 and p=0.006) improved in both groups. The improvements in MMAS1-5 and ten meters walking time did not differ between the groups (p=0.217 and p=0.195). Specific gait characteristics improved only in the intervention group, as seen in increased Functional Ambulation Profile score (p=0.0...
Duodecim; lääketieteellinen aikakauskirja, 2002
Neuroscience Research, 2015
Paired associative stimulation (PAS) is a non-invasive stimulation method developed to induce bid... more Paired associative stimulation (PAS) is a non-invasive stimulation method developed to induce bidirectional changes in the excitability of the cortical projections to the target muscles. However, very few studies have shown an association between changes in motor evoked potentials (MEP) after PAS and behavioral changes in healthy subjects. In the present study we hypothesized that the functional relevance of PAS can be seen during fatiguing exercise, since there is always a central contribution to the development of fatigue. Transcranial magnetic stimulation was applied over the motor cortex to measure changes in the MEPs of the soleus muscle before and after PAS. Furthermore, fatigue resistance was tested during 15 s sustained maximal isometric contractions before and after PAS. On average, fatigue resistance did not change after PAS, however the change in excitability correlated significantly with the change in fatigue resistance. Discussion: Functionality of PAS intervention was not demonstrated in this study. However, the observed relationship between excitability and fatigue resistance suggests that PAS might have affected central fatigue during short maximal contractions.
Functional outcome of stroke patients depends on various factors such as rapid access to the emer... more Functional outcome of stroke patients depends on various factors such as rapid access to the emergency ward, care in the stroke unit and level of the rehabilitation. Stroke, infarction or intracerebral hemorrhage may cause motor weakness, sensory and proprioceptive deficits, intellectual impairment, emotional distress and motivational and social problems. Although most stroke patients regain walking independence, many have continuing problems with mobility due to impaired balance, motor weakness, and decreased walking velocity. The main purpose of this study was to evaluate gait rehabilitation in patients over six months poststroke. First, the amount and content of the exercise of a tailored three-week gait-oriented physiotherapy program was analysed in an in-patient rehabilitation setting. Subsequently, the postural control, the spatio-temporal gait characteristics and the effects of the gait-oriented rehabilitation were analysed. Static balance was assessed with the emphasis on differentiating the left and right hemiparesis. The gait-oriented rehabilitation was compared with conventional rehabilitation. Additionally, three gait-oriented rehabilitation strategies were compared: the bodyweight supported (BWS) gait trainer exercise with functional electrical stimulation (FES), the BWS gait trainer exercise without FES and active walking exercise. The study population consisted of 59 patients with chronic stroke and 30 healthy subjects. Their motor abilities were studied with a battery of measurements and the details of the therapy were recorded. Comparison of three gait-oriented rehabilitation strategies revealed no differences between groups in motor improvements. Gait improved 14-24 % after 28 hours of instructed physiotherapy and self-initiated training in the gait-oriented groups and their dynamic balance improved by 28-48 %. The patients seemed to depend on a larger postural sway than healthy subjects to maintain their static balance and there may be specific features due to the side of the hemiparesis. Gait-oriented rehabilitation improved certain spatiotemporal gait characteristics not seen in less intensive conventional rehabilitation. All gaitoriented strategies were good choices for ambulatory stroke patients. The follow-up of six months showed no decline in gains in gait. The same time frame in the gait trainer allowed more repetitions of steps and a longer walking distance. Intensive training improved gait in patients with chronic stroke and may lead to increased options for daily activities.
The Journal of Rehabilitation Research and Development, 2007
We assessed the effects and strenuousness of intensive gait-oriented inpatient rehabilitation ini... more We assessed the effects and strenuousness of intensive gait-oriented inpatient rehabilitation initiated very early after stroke. Therapy content and interrater reliability of the assessments were also analyzed. Of 22 patients, 19 (average 8.0 d poststroke) completed the study. Before rehabilitation, 13 patients were unable to walk or needed two assistants to walk and 6 patients needed one assistant. Patients spent a daily maximum of 1 h therapy time to obtain 20 min of walking. Additional physiotherapy was also provided during the 3 wk therapy period. Seven structured motor tests were recorded before and after rehabilitation and at 6 months postrehabilitation, and perceived exertion was followed during physiotherapy. After rehabilitation, 16 patients could walk unassisted and 3 needed one assistant to walk. Mean +/-standard deviation exercise walking distance was 10,784 +/-4,446 m and exercise was ranked as slightly strenuous. After 3 wk, the patients' 10 m walking time, ankle spasticity, lower-limb muscle force, and motor scale scores improved (p < 0.05). The early intensive rehabilitation was well tolerated and only three patients dropped out. Improved motor abilities were seen in all stroke patients.
Journal of Rehabilitation Medicine, 2012
Objective: to determine the effects of physiotherapy inter ventions on balance in people with mul... more Objective: to determine the effects of physiotherapy inter ventions on balance in people with multiple sclerosis. Data sources: A systematic literature search was conducted in Medline, cinahl, embase, PeDro, both electronically and by manual search up to March 2011. Study selection: Randomized controlled trials of physiothe rapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classifica tion of Functioning, Disability and Health (icF) category of "changing and maintaining body position", were included. Data extraction: the quality of studies was determined by the van tulder criteria. Metaanalyses were performed in subgroups according to the intervention. Data synthesis: After screening 233 fulltext papers, 11 stud ies were included in a qualitative analysis and 7 in a meta analysis. the methodological quality of the studies ranged from poor to moderate. Low evidence was found for the effi cacy of specific balance exercises, physical therapy based on an individualized problemsolving approach, and resistance and aerobic exercises on improving balance among ambula tory people with multiple sclerosis. Conclusion: These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.
Journal of Neurology, 2004
Background and Purpose Physical exercise therapy in sensorimotor rehabilitation of stroke patient... more Background and Purpose Physical exercise therapy in sensorimotor rehabilitation of stroke patients includes active and repetitive exercise and task-specific training. The time spent in active practice is fundamental. The pur
Gait & Posture, 2005
Chapter 17. Sensorimotor deficits' following stroke Results: Similar peak MURs were obtained betw... more Chapter 17. Sensorimotor deficits' following stroke Results: Similar peak MURs were obtained between paretic and non-paretic sides (p> 0.005). For the paretic side, peak MUR reached mean (SD) values (%) of 67.7(20.8), 38.4(15.6) and 25.7(25.5) for plantarflexors, hip flexors and extensors at self-selected pace, respectively. The corresponding values (%) at maximal pace were 79.7(23.0), 58.7(17.4) and 44.4(26.9). At both paces, peak MURs were highest at the ankle. The difference in the peak MURs between self-selected and maximal paces was significant for all muscle groups but changes were greater at the hip. Discussion and conclusion: Data showed that hemiparetic participants utilized the same proportion of their maximal strength on both sides during gait. As for healthy subjects, the highest proportion was observed in the plantarflexors and hip muscles were the most modified by gait pace. [1~4] Assessing the visual, the haptic, and the postural vertical in stroke patients: which modality best explains the postural disability.'?
Clinical Rehabilitation, 2002
Objective: To investigate whether cutaneous electrical stimulation has a role in the enhancement ... more Objective: To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke. Subjects and setting: Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation. Thirty-two received active treatment in the paretic hand and eight received no-current placebo treatment in the paretic hand. Nineteen patients received active stimulation of the paretic foot. None received stimulation in both upper and lower limbs. Intervention: Cutaneous stimulation was delivered twice daily via a special glove/sock electrode. Main outcome measures: Modified Motor Assessment Scale, 10-metre walking test, paretic limb function, limb skin sensation and somatosensory evoked potentials (SEP) were performed before and after the treatment. Results: Modified Motor Assessment Scale ( p < 0.001), 10-metre walking test ( p < 0.05), paretic hand function ( p < 0.01), upper limb skin...
Clinical Neurophysiology, 2011
S5.3 Prognostic value of contralesional delta band EEG activity in acute stroke G. Assenza1, F. Z... more S5.3 Prognostic value of contralesional delta band EEG activity in acute stroke G. Assenza1, F. Zappasodi2, P. Pasqualetti3, S. Assenza4, M. Ercolani5, L. Fraioli6, C. Gaudino7, F. Passarelli8, F. Tibuzzi9, F. Vernieri1, P.M. Rossini1, F. Tecchio10 1Neurologia Clinica, Università Campus Biomedico, Rome, Italy, 2Department of Clinical Sciences and Bioimaging, G. D’Annunzio University, Chieti-Pescara, Italy, 3Medical Statistics & Information Technology, Fatebenefratelli Association for Research, Rome, Italy, 4Casa di Cura San Raffaele Cassino, Cassino, Italy, 5AFaR, Department of Neuroscience, Hosp. Fatebenefratelli, Isola Tiberina, Rome, Italy, 6Casa di Cura San Raffaele Cassino, Rome, Italy, 7Radiologia e Diagnostica per immagini, Università Campus Biomedico, Rome, Italy, 8Dipartimento di Neuroscienze Ospedale Fatefenefratelli, Isola Tiberina, Rome, Italy, 9Dipartimento di Neuroscienze Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy, 10LET’S Laboratory of Electrophysiology for Translational neuroScience Unità MEG Osp. FBF Isola tiberina, Rome, Italy
Archives of Physical Medicine and Rehabilitation, 2005
Objective: To compare body weight-supported exercise on a gait trainer with walking exercise over... more Objective: To compare body weight-supported exercise on a gait trainer with walking exercise overground. Design: Randomized controlled trial. Setting: Rehabilitation hospital. Participants: Forty-five ambulatory patients with chronic stroke. Interventions: Patients were randomized to 3 groups: (1) gait trainer exercise with functional electric stimulation (GT stim), (2) gait trainer exercise without stimulation (GT), and (3) walking overground (WALK). All patients practiced gait for 15 sessions during 3 weeks (each session, 20min), and they received additional physiotherapy 55 minutes daily. Main Outcome Measures: Ten-meter walk test (10MWT), six-minute walk test (6MWT), lower-limb spasticity and muscle force, postural sway tests, Modified Motor Assessment Scale (MMAS), and FIM instrument scores were recorded before, during, and after the rehabilitation and at 6 months follow-up. Results: The mean walking distance using the gait trainer was 6900Ϯ1200m in the GT stim group and 6500Ϯ1700m in GT group. In the WALK group, the distance was 4800Ϯ2800m, which was less than the walking distance obtained in the GT stim group (Pϭ.027). The bodyweight support was individually reduced from 30% to 9% of the body weight over the course of the program. In the pooled 45 patients, the 10MWT (PϽ.001), 6MWT (PϽ.001), MMAS (PϽ.001), dynamic balance test time (PϽ.001), and test trip (Pϭ.005) scores improved; however, no differences were found between the groups. Conclusions: Both the body weight-supported training and walking exercise training programs resulted in faster gait after the intensive rehabilitation program. Patients' motor performance remained improved at the follow-up.
Kuopion yliopisto, Jun 15, 2005
Functional outcome of stroke patients depends on various factors such as rapid access to the emer... more Functional outcome of stroke patients depends on various factors such as rapid access to the emergency ward, care in the stroke unit and level of the rehabilitation. Stroke, infarction or intracerebral hemorrhage may cause motor weakness, sensory and proprioceptive deficits, intellectual impairment, emotional distress and motivational and social problems. Although most stroke patients regain walking independence, many have continuing problems with mobility due to impaired balance, motor weakness, and decreased walking velocity. The main purpose of this study was to evaluate gait rehabilitation in patients over six months poststroke. First, the amount and content of the exercise of a tailored three-week gait-oriented physiotherapy program was analysed in an in-patient rehabilitation setting. Subsequently, the postural control, the spatio-temporal gait characteristics and the effects of the gait-oriented rehabilitation were analysed. Static balance was assessed with the emphasis on differentiating the left and right hemiparesis. The gait-oriented rehabilitation was compared with conventional rehabilitation. Additionally, three gait-oriented rehabilitation strategies were compared: the bodyweight supported (BWS) gait trainer exercise with functional electrical stimulation (FES), the BWS gait trainer exercise without FES and active walking exercise. The study population consisted of 59 patients with chronic stroke and 30 healthy subjects. Their motor abilities were studied with a battery of measurements and the details of the therapy were recorded. Comparison of three gait-oriented rehabilitation strategies revealed no differences between groups in motor improvements. Gait improved 14-24 % after 28 hours of instructed physiotherapy and self-initiated training in the gait-oriented groups and their dynamic balance improved by 28-48 %. The patients seemed to depend on a larger postural sway than healthy subjects to maintain their static balance and there may be specific features due to the side of the hemiparesis. Gait-oriented rehabilitation improved certain spatiotemporal gait characteristics not seen in less intensive conventional rehabilitation. All gaitoriented strategies were good choices for ambulatory stroke patients. The follow-up of six months showed no decline in gains in gait. The same time frame in the gait trainer allowed more repetitions of steps and a longer walking distance. Intensive training improved gait in patients with chronic stroke and may lead to increased options for daily activities.
Liiteluettelo Liite 1. RBDI-testilomake. Liite 2. SOC-13-testilomake. Liite 3. WMF T-testilomake.... more Liiteluettelo Liite 1. RBDI-testilomake. Liite 2. SOC-13-testilomake. Liite 3. WMF T-testilomake. Liite 4. Pinch-testilomake. Liite 5. Kävelyn kuntoutuksen kotikäyntilomake. Liite 6. Käden tehostetun käytön kuntoutuksen kotikäyntilomake. Liite 7. Ar viointimenetelmäkäsit teiden jakautuminen ICF-luokituksen pääluokkiin (1. luokitusporras) luokituksen eri osa-alueilla. Liite 8. Kävelyn kuntoutuksen perusjakson kyselylomake. Liite 9. Käden tehostetun käytön kuntoutuksen perusjakson kyselylomake. Liite 10. Kävelyn kuntoutuksen seurantajakson I kyselylomake. Liite 11. Käden tehostetun käytön kuntoutuksen seurantajakson I kyselylomake. Liite 12. Alkukyselylomake. Liite 13. Seurantakysely I (6 kk). Liite 14. Seurantakysely II (12 kk). Liitteet ovat tämän julkaisun sähköisen version yhteydessä.
AbstractObjective: To examine the effect of constraint-induced movement therapy and modified cons... more AbstractObjective: To examine the effect of constraint-induced movement therapy and modified constraint-induced movement therapy on activity and participation of patients with stroke (i.e. the effect of differenttreatment durations and frequency) by reviewing the results of randomized controlled trials.Data sources: A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, PEDro,OTSeeker, CENTRAL and by manual search.Reviewmethods:Randomizedcontrolledtrialsforpatientsover18yearsoldwithstrokeandpublishedinFinnish,Swedish,EnglishorGermanwereincluded.StudieswerecollecteduptothefirstweekinMay2011.The evidence was high, moderate, low or no evidence according to the quality of randomized controlledtrial and the results of meta-analyses.Results: Search resulted in 30 papers reporting constraint-induced movement therapy, including 27 ran-domized controlled trials published between 2001 and 2011. Constraint-induced movement therapy prac-tice for 60–72 hours over two weeks prod...
Käden pakotetun käytön ohjelma on uusi kuntoutusmenetelmä. Tämän tutkimuksen tarkoitus on ollut t... more Käden pakotetun käytön ohjelma on uusi kuntoutusmenetelmä. Tämän tutkimuksen tarkoitus on ollut tutkia menetelmän tehokkuutta kroonisilla aivohalvauspotilailla, joille on jäänyt yläraajaan käden normaalin käytön pysyvästi estävä vamma. Kuntoutusohjelmassa potilaan koko huomio ja ponnistukset kohdennetaan vammautuneeseen yläraajaan. Kättä harjoitetaan monipuolisesti ennalta suunnitelluin ohjatuin harjoituksin kokopäivätoimisesti kahden viikon ajan. Tutkimukseen hyväksyttiin 33 potilasta, joille tehtiin harjoitusjaksoa edeltävä alkutesti ja jakson jälkeen lopputesti. Käden toimintakyky parani heillä merkitsevästi. Potilaista 16 osallistui perustason mittaukseen kaksi viikkoa ennen harjoitusohjelmaa ja seurantatestaukseen kolme kuukautta hoitojakson päättymisen jälkeen. Kahden viikon harjoittelujakson jälkeen tehtävistä suoriutuminen nopeutui siten, että testin suorittamiseen kulunut aika puolittui. Myös toimintakyky parani yleensä merkitsevästi, samoin kuin liikesuorituksen laadukkuus...
320 s. + 69 sähköistä liitettä Laki Kelan kuntoutuksesta määrittää, että kuntoutuksen tulee olla ... more 320 s. + 69 sähköistä liitettä Laki Kelan kuntoutuksesta määrittää, että kuntoutuksen tulee olla hyvän kuntoutuskäytännön mukaista. Tämän Vaikeavammaisten kuntoutuksen kehittämishankkeeseen (VAKE) kuuluvan tutkimuksen tavoitteena oli kolmen diagnoosiryhmän – aivoverenkiertohäiriön (AVH), multippeliskleroosin (MS) ja Cerebral Palsyn (CP) – avulla kuvata Kelan järjestämän vaikeavammaisten lääkinnällisen kuntoutuksen nykytilaa, sen kehittämistarpeita ja eri kuntoutustoimenpiteiden vaikuttavuutta sekä laatia suositukset hyvästä kuntoutuskäytännöstä. Tutkimus toteutettiin laajassa tutkimusyhteistyössä vuosina 2007–2009. Kirjan toisessa osassa kuvataan AVH-, MS- ja CP-kuntoutuksen nykykäytännöt, jotka perustuvat kuntoutusalan ammattilaisille ja asiantuntijoille tehtyihin kysely- ja haastattelututkimuksiin, sekä esitellään Kelalle lähetettyjen kuntoutussuunnitelmien analyysit. Kirjan kolmas osa käsittelee kuntoutuksen arviointikäytäntöjä. Tulokset perustuvat nykykäytäntöjä selvittäneisiin ...
The ICF (International Classification of Functioning, Disability and Health) was translated to Fi... more The ICF (International Classification of Functioning, Disability and Health) was translated to Finnish in 2004. However, lack of systematic education, clinical networks, a Finnish electronic version, and practical tools has prevented its widespread utilization in clinical practice. Networks can encourage partnerships in research, development and implementation activities. The National Institute for Health and Welfare (THL) initiated a learning network on the ICF issues in “Innovillage” during autumn 2012. This paper describes the objectives, connections and the initiated activities of the ICF learning network in Finland. The ICF learning network is open for all interested in learning, education, development and research considering the ICF. It aims to identify challenges, develop, evaluate and disseminate the ICF-based practices by organizing workshops on the ICF-related topics. The network utilizes the developed virtual tools and services in “Innovillage” (joint workspace, project ...
Restorative neurology and neuroscience, 2007
It is known that visuospatial orientation and the extent of spontaneous recovery vary between rig... more It is known that visuospatial orientation and the extent of spontaneous recovery vary between right or left hemisphere affected stroke patients. We hypothesized that the right hemisphere affected chronic patients would show more impaired static balance than left hemisphere affected patients. The purpose of the study was to assess displacement of the center of pressure (COP) of ambulatory patients with either left or right hemiparesis. Forty-five patients and thirty healthy subjects participated and static balance was measured while standing on a force plate. The patients showed more than four times higher mean velocity moment and two times faster anterior-posterior (AP) and medial-lateral (ML) speed of COP displacement than healthy subjects. The patients with left hemiparesis, and affected right hemisphere, had higher power peak magnitudes of COP displacements than patients with right hemiparesis both in ML and AP directions at low frequencies. The patients had higher power peak mag...
Restorative neurology and neuroscience, 2005
To assess the effects of rehabilitation in thirty-seven ambulatory patients with chronic stroke d... more To assess the effects of rehabilitation in thirty-seven ambulatory patients with chronic stroke during three weeks in-patient rehabilitation period. In the intervention group, each patient received 75 min physiotherapy daily every workday including 20 minutes in the electromechanical gait trainer with body-weight support (BWS). In the control group, each patient participated in 45 min conventional physiotherapy daily. Motor ability was assessed with the first five items of the Modified Motor Assessment Scale (MMAS1-5) and ten meters walking speed. Spatio-temporal gait characteristics were recorded with an electrical walkway. The MMAS1-5 (p<0.0005 and p=0.005) and ten meters walking time (p<0.0005 and p=0.006) improved in both groups. The improvements in MMAS1-5 and ten meters walking time did not differ between the groups (p=0.217 and p=0.195). Specific gait characteristics improved only in the intervention group, as seen in increased Functional Ambulation Profile score (p=0.0...
Duodecim; lääketieteellinen aikakauskirja, 2002
Neuroscience Research, 2015
Paired associative stimulation (PAS) is a non-invasive stimulation method developed to induce bid... more Paired associative stimulation (PAS) is a non-invasive stimulation method developed to induce bidirectional changes in the excitability of the cortical projections to the target muscles. However, very few studies have shown an association between changes in motor evoked potentials (MEP) after PAS and behavioral changes in healthy subjects. In the present study we hypothesized that the functional relevance of PAS can be seen during fatiguing exercise, since there is always a central contribution to the development of fatigue. Transcranial magnetic stimulation was applied over the motor cortex to measure changes in the MEPs of the soleus muscle before and after PAS. Furthermore, fatigue resistance was tested during 15 s sustained maximal isometric contractions before and after PAS. On average, fatigue resistance did not change after PAS, however the change in excitability correlated significantly with the change in fatigue resistance. Discussion: Functionality of PAS intervention was not demonstrated in this study. However, the observed relationship between excitability and fatigue resistance suggests that PAS might have affected central fatigue during short maximal contractions.
Functional outcome of stroke patients depends on various factors such as rapid access to the emer... more Functional outcome of stroke patients depends on various factors such as rapid access to the emergency ward, care in the stroke unit and level of the rehabilitation. Stroke, infarction or intracerebral hemorrhage may cause motor weakness, sensory and proprioceptive deficits, intellectual impairment, emotional distress and motivational and social problems. Although most stroke patients regain walking independence, many have continuing problems with mobility due to impaired balance, motor weakness, and decreased walking velocity. The main purpose of this study was to evaluate gait rehabilitation in patients over six months poststroke. First, the amount and content of the exercise of a tailored three-week gait-oriented physiotherapy program was analysed in an in-patient rehabilitation setting. Subsequently, the postural control, the spatio-temporal gait characteristics and the effects of the gait-oriented rehabilitation were analysed. Static balance was assessed with the emphasis on differentiating the left and right hemiparesis. The gait-oriented rehabilitation was compared with conventional rehabilitation. Additionally, three gait-oriented rehabilitation strategies were compared: the bodyweight supported (BWS) gait trainer exercise with functional electrical stimulation (FES), the BWS gait trainer exercise without FES and active walking exercise. The study population consisted of 59 patients with chronic stroke and 30 healthy subjects. Their motor abilities were studied with a battery of measurements and the details of the therapy were recorded. Comparison of three gait-oriented rehabilitation strategies revealed no differences between groups in motor improvements. Gait improved 14-24 % after 28 hours of instructed physiotherapy and self-initiated training in the gait-oriented groups and their dynamic balance improved by 28-48 %. The patients seemed to depend on a larger postural sway than healthy subjects to maintain their static balance and there may be specific features due to the side of the hemiparesis. Gait-oriented rehabilitation improved certain spatiotemporal gait characteristics not seen in less intensive conventional rehabilitation. All gaitoriented strategies were good choices for ambulatory stroke patients. The follow-up of six months showed no decline in gains in gait. The same time frame in the gait trainer allowed more repetitions of steps and a longer walking distance. Intensive training improved gait in patients with chronic stroke and may lead to increased options for daily activities.
The Journal of Rehabilitation Research and Development, 2007
We assessed the effects and strenuousness of intensive gait-oriented inpatient rehabilitation ini... more We assessed the effects and strenuousness of intensive gait-oriented inpatient rehabilitation initiated very early after stroke. Therapy content and interrater reliability of the assessments were also analyzed. Of 22 patients, 19 (average 8.0 d poststroke) completed the study. Before rehabilitation, 13 patients were unable to walk or needed two assistants to walk and 6 patients needed one assistant. Patients spent a daily maximum of 1 h therapy time to obtain 20 min of walking. Additional physiotherapy was also provided during the 3 wk therapy period. Seven structured motor tests were recorded before and after rehabilitation and at 6 months postrehabilitation, and perceived exertion was followed during physiotherapy. After rehabilitation, 16 patients could walk unassisted and 3 needed one assistant to walk. Mean +/-standard deviation exercise walking distance was 10,784 +/-4,446 m and exercise was ranked as slightly strenuous. After 3 wk, the patients' 10 m walking time, ankle spasticity, lower-limb muscle force, and motor scale scores improved (p < 0.05). The early intensive rehabilitation was well tolerated and only three patients dropped out. Improved motor abilities were seen in all stroke patients.
Journal of Rehabilitation Medicine, 2012
Objective: to determine the effects of physiotherapy inter ventions on balance in people with mul... more Objective: to determine the effects of physiotherapy inter ventions on balance in people with multiple sclerosis. Data sources: A systematic literature search was conducted in Medline, cinahl, embase, PeDro, both electronically and by manual search up to March 2011. Study selection: Randomized controlled trials of physiothe rapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classifica tion of Functioning, Disability and Health (icF) category of "changing and maintaining body position", were included. Data extraction: the quality of studies was determined by the van tulder criteria. Metaanalyses were performed in subgroups according to the intervention. Data synthesis: After screening 233 fulltext papers, 11 stud ies were included in a qualitative analysis and 7 in a meta analysis. the methodological quality of the studies ranged from poor to moderate. Low evidence was found for the effi cacy of specific balance exercises, physical therapy based on an individualized problemsolving approach, and resistance and aerobic exercises on improving balance among ambula tory people with multiple sclerosis. Conclusion: These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.
Journal of Neurology, 2004
Background and Purpose Physical exercise therapy in sensorimotor rehabilitation of stroke patient... more Background and Purpose Physical exercise therapy in sensorimotor rehabilitation of stroke patients includes active and repetitive exercise and task-specific training. The time spent in active practice is fundamental. The pur
Gait & Posture, 2005
Chapter 17. Sensorimotor deficits' following stroke Results: Similar peak MURs were obtained betw... more Chapter 17. Sensorimotor deficits' following stroke Results: Similar peak MURs were obtained between paretic and non-paretic sides (p> 0.005). For the paretic side, peak MUR reached mean (SD) values (%) of 67.7(20.8), 38.4(15.6) and 25.7(25.5) for plantarflexors, hip flexors and extensors at self-selected pace, respectively. The corresponding values (%) at maximal pace were 79.7(23.0), 58.7(17.4) and 44.4(26.9). At both paces, peak MURs were highest at the ankle. The difference in the peak MURs between self-selected and maximal paces was significant for all muscle groups but changes were greater at the hip. Discussion and conclusion: Data showed that hemiparetic participants utilized the same proportion of their maximal strength on both sides during gait. As for healthy subjects, the highest proportion was observed in the plantarflexors and hip muscles were the most modified by gait pace. [1~4] Assessing the visual, the haptic, and the postural vertical in stroke patients: which modality best explains the postural disability.'?
Clinical Rehabilitation, 2002
Objective: To investigate whether cutaneous electrical stimulation has a role in the enhancement ... more Objective: To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke. Subjects and setting: Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation. Thirty-two received active treatment in the paretic hand and eight received no-current placebo treatment in the paretic hand. Nineteen patients received active stimulation of the paretic foot. None received stimulation in both upper and lower limbs. Intervention: Cutaneous stimulation was delivered twice daily via a special glove/sock electrode. Main outcome measures: Modified Motor Assessment Scale, 10-metre walking test, paretic limb function, limb skin sensation and somatosensory evoked potentials (SEP) were performed before and after the treatment. Results: Modified Motor Assessment Scale ( p < 0.001), 10-metre walking test ( p < 0.05), paretic hand function ( p < 0.01), upper limb skin...
Clinical Neurophysiology, 2011
S5.3 Prognostic value of contralesional delta band EEG activity in acute stroke G. Assenza1, F. Z... more S5.3 Prognostic value of contralesional delta band EEG activity in acute stroke G. Assenza1, F. Zappasodi2, P. Pasqualetti3, S. Assenza4, M. Ercolani5, L. Fraioli6, C. Gaudino7, F. Passarelli8, F. Tibuzzi9, F. Vernieri1, P.M. Rossini1, F. Tecchio10 1Neurologia Clinica, Università Campus Biomedico, Rome, Italy, 2Department of Clinical Sciences and Bioimaging, G. D’Annunzio University, Chieti-Pescara, Italy, 3Medical Statistics & Information Technology, Fatebenefratelli Association for Research, Rome, Italy, 4Casa di Cura San Raffaele Cassino, Cassino, Italy, 5AFaR, Department of Neuroscience, Hosp. Fatebenefratelli, Isola Tiberina, Rome, Italy, 6Casa di Cura San Raffaele Cassino, Rome, Italy, 7Radiologia e Diagnostica per immagini, Università Campus Biomedico, Rome, Italy, 8Dipartimento di Neuroscienze Ospedale Fatefenefratelli, Isola Tiberina, Rome, Italy, 9Dipartimento di Neuroscienze Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy, 10LET’S Laboratory of Electrophysiology for Translational neuroScience Unità MEG Osp. FBF Isola tiberina, Rome, Italy
Archives of Physical Medicine and Rehabilitation, 2005
Objective: To compare body weight-supported exercise on a gait trainer with walking exercise over... more Objective: To compare body weight-supported exercise on a gait trainer with walking exercise overground. Design: Randomized controlled trial. Setting: Rehabilitation hospital. Participants: Forty-five ambulatory patients with chronic stroke. Interventions: Patients were randomized to 3 groups: (1) gait trainer exercise with functional electric stimulation (GT stim), (2) gait trainer exercise without stimulation (GT), and (3) walking overground (WALK). All patients practiced gait for 15 sessions during 3 weeks (each session, 20min), and they received additional physiotherapy 55 minutes daily. Main Outcome Measures: Ten-meter walk test (10MWT), six-minute walk test (6MWT), lower-limb spasticity and muscle force, postural sway tests, Modified Motor Assessment Scale (MMAS), and FIM instrument scores were recorded before, during, and after the rehabilitation and at 6 months follow-up. Results: The mean walking distance using the gait trainer was 6900Ϯ1200m in the GT stim group and 6500Ϯ1700m in GT group. In the WALK group, the distance was 4800Ϯ2800m, which was less than the walking distance obtained in the GT stim group (Pϭ.027). The bodyweight support was individually reduced from 30% to 9% of the body weight over the course of the program. In the pooled 45 patients, the 10MWT (PϽ.001), 6MWT (PϽ.001), MMAS (PϽ.001), dynamic balance test time (PϽ.001), and test trip (Pϭ.005) scores improved; however, no differences were found between the groups. Conclusions: Both the body weight-supported training and walking exercise training programs resulted in faster gait after the intensive rehabilitation program. Patients' motor performance remained improved at the follow-up.