Description of a new motor re-education programme for the paretic lower limb aimed at improving the mobility of stroke patients (original) (raw)
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Stroke rehabilitation. Three exercise therapy approaches
Physical therapy, 1986
The purpose of this study was to compare the therapeutic efficacy of three exercise therapy approaches. Three groups of adult stroke patients (N = 131) participated in the study. The first group received conventional treatment that consisted of traditional exercises and functional activities. The treatment of the second group was based on proprioceptive neuromuscular facilitation techniques. The third group was treated using the Bobath approach. The improvement of each patient was evaluated after six weeks of treatment in terms of functional gains in activities of daily living as measured using the Barthel index, changes in the muscle tone of the involved limbs as measured using a five-point ordinal scale, changes in the isolated motor control of the ankle and wrist as measured by tests of muscle strength and range of motion, and changes in the patients' ambulatory status as measured using a nominal scale of four categories. The therapeutic effects of exercise according to each ...
Evidence-Based Stroke Rehabilitation
Facta Universitatis, Series: Medicine and Biology, 2017
Stroke can have different clinical characteristics and consequences, with unequal disability and outcome, thus demanding individual approach, specific skills and general knowledge. Treatment of stroke has significantly improved during the last twenty years, mainly because of clinical and experimental studies, adequate medicamentous therapy, and the use of new technologies as well. Use-dependent rehabilitation strategy includes repetitive training with proper adjustment of the program. Other rehabilitation practices should also be incorporated, such as self-care, recreation, and home-based activities. Motivation of the patients, improving quality of life, functional independence, activities of daily life are crucial. Holistic approach means that the patient as a whole should be considered and treated. Scientific evidence is sufficient to confirm the necessity of physical rehabilitation of patients after stroke in order to achieve the optimal results. Current evidence on the effect of physical therapy in stroke rehabilitation is presented.
Comparison of the content of two physiotherapy approaches for stroke
Clinical Rehabilitation, 2001
To identify similarities and differences between a Bobath-based (BB) and a movement science-based (MSB) approach. Design: Direct observation by a trained observer was used to record behaviours during treatments. Setting: An acute stroke ward. Subjects: Twenty-two stroke patients. Interventions: Behaviours were recorded during 12 treatment sessions by three therapists, for each treatment approach. Physical and communication behaviours were recorded in pre-defined categories. The equipment used was recorded and a semi-structured interview conducted with the therapist after treatment to identify follow-up actions by the therapist. Main outcome measures: Frequency of occurrence of each category was compared between the approaches. Results: Treatment in the BB group contained more social conversation (p = 0.004), and more use of physiotherapy equipment (p = 0.02) and a physiotherapy assistant (p = 0.01). In the MSB group there was more detailed feedback given to the patient (p = 0.002) more use of everyday objects in training (p = 0.001), therapists more frequently listed specific components as the patient's main problems (p = 0.003) and relatives were involved more in positioning to stretch muscles (p = 0.03). Training walking was given more emphasis in the BB group and training of sit-to-stand in the MSB group. Conclusions: The study indicates that there are differences in content between the Bobath-based and movement science-based approaches to treatment.
Rehabilitation After Stroke: Early Findings from a
2015
Background: Stroke significantly affects thousands of individuals annually, leading to considerable physical impairment and functional disability. Gait is one of the most important activities of daily living affected in stroke survivors. Recent technological developments in powered robotics exoskeletons can create powerful adjunctive tools for rehabilitation and potentially accelerate functional recovery. Here, we present the development and evaluation of a novel lower limb robotic exoskeleton, namely H2 (Technaid S.L., Spain), for gait rehabilitation in stroke survivors. Methods: H2 has six actuated joints and is designed to allow intensive overground gait training. An assistive gait control algorithm was developed to create a force field along a desired trajectory, only applying torque when patients deviate from the prescribed movement pattern. The device was evaluated in 3 hemiparetic stroke patients across 4 weeks of training per individual (approximately 12 sessions). The study was approved by the Institutional Review Board at the University of Houston. The main objective of this initial pre-clinical study was to evaluate the safety and usability of the exoskeleton. A Likert scale was used to measure patient's perception about the easy of use of the device. Results: Three stroke patients completed the study. The training was well tolerated and no adverse events occurred. Early findings demonstrate that H2 appears to be safe and easy to use in the participants of this study. The overground training environment employed as a means to enhance active patient engagement proved to be challenging and exciting for patients. These results are promising and encourage future rehabilitation training with a larger cohort of patients. Conclusions: The developed exoskeleton enables longitudinal overground training of walking in hemiparetic patients after stroke. The system is robust and safe when applied to assist a stroke patient performing an overground walking task. Such device opens the opportunity to study means to optimize a rehabilitation treatment that can be customized for individuals. Trial registration: This study was registered at ClinicalTrials.gov (NCT02114450).
Biomedical Human Kinetics, 2022
Study aim: To check if the short rehabilitation treatment (3 weeks) complemented by complex rehabilitation on advanced equipment improves the functional status of chronic stroke patients; and which clinical and objective parameters can be used to assess the efficacy of such treatment. Material and methods: 28 patients 3 to 6 months after the stroke. They participated in 3 weeks rehabilitation program in Rehabilitation Hospital. This program was supplemented by rehabilitation on: Zebris treadmill, ALFA and GAMMA platform, Biodex Balance System SD, the Balance Tutor treadmill. Their functional status was assessed by: Scandinavian Stroke Scale (SSS), Timed-Up-And-Go test (TUG), balance tests on Zebris, instrumented gait analysis on BTS system. Results: The positive changes of the patients' functional status were found in time of TUG test, in case of balance test for 95% of the ellipsoid area, lengths of major and minor axes of the ellipsoid, average sway speed, sway path length, total ground reaction force for left and right leg, and Gillette Gait Index in case of the gait analysis. Conclusions: The improvement of the functional status of chronic stroke patients after relatively short rehabilitation treatment was achieved, due to the addition to the standard rehabilitation treatment the program on the advanced technologically equipment.
Clinical Rehabilitation, 2011
To test a study design and explore the feasibility and potential effects of conventional neurological therapy, constraint induced therapy and therapeutic climbing to improve minimal to moderate arm and hand function in patients after a stroke. A pilot study with six-month follow-up in patients after stroke with minimal to moderate arm and hand function admitted for inpatient rehabilitation was performed. Participants were randomly allocated to one of three treatment approaches. Main outcomes were improvement of arm and hand function and adverse effects. 283 patients with stroke were screened for inclusion over a two-year period, out of which fourtyfour were included. All patients could be treated according to the protocol. Improvement of arm and hand function was significantly higher in conventional neurological therapy and constraint induced therapy compared with therapeutic climbing at discharge, and at six months follow-up (P < 0.05, effect size = 0.56-0.76). No significant differences in arm and hand function were observed between constraint induced therapy and conventional neurological therapy. Constraint induced therapy participants were significantly less at risk of developing shoulder pain at six months follow-up compared with the other participants (P < 0.05, effect size = 0.82 and 1.79, respectively). The study design needs adaptation to accommodate the stringent inclusion criteria leading to prolonged study duration. Constraint induced therapy seems to be the optimal approach to improve arm and hand function and minimize the risk of shoulder pain for patients with minimal to moderate arm hand function after stroke in the intermediate term.
Brain Injury, 2014
Introduction: Physical activity is mandatory if patients are to remain healthy and independent after stroke. Objective: Maintenance of motor function (Motor Assessment Scale),tone (Modified Ashworth Scale), grip strength (Martin Vigorimeter), balance (Berg Balance Scale), mobility (Timed Up-and-Go), gait (6 Minute-Walk-Test), independence in personal and instrumental activities of daily living ((Barthel Index), health-related quality of life (Nottingham Health Profile) and an active life style four years post- stroke Method: A prospective randomized controlled trial. Results: Four years post-stroke 37 of the 75 participating persons were eligible for follow up; 19 (54.3%) from the intensive exercise group and 18 (45%) from the regular exercise group. Both groups were performing equally well with no significant differences in total scores on the BI (p= 0.3), MAS (p=0.4), BBS (p= 0.1), TUG (p=0.08), 6MWT (p=0.1), bilateral grip strength (affected hand, p=0.8; non-affected hand, p=0.9) nor in the items of NHP (p>0.005). Independence in performing the IADL was 40%, 60 % had help from relatives or community-based services. Conclusion: This longitudinal follow up study shows that patients with stroke in two different groups with exercise regimes during the first year after stroke had a relatively active life style four years following the acute incident and did not differ in long-term outcomes. The results underline the importance of follow-up testing and encouragement to exercise, to motivate and sustain physical activity patterns, so that physical functions maintained, not only in the acute but also in the chronic phase of stroke.