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Variables
Independent: gender, age, hemisphere of stroke, type of stroke, days between stroke
and first assessment, recombinant tissue plasminogen activator, comorbidity, visual
inattention, deviation conjugee, sensory loss, Activities of Daily Living score from
Barthel Index, urinary incontinence, severity and extent of paresis in arm and leg
from Motricity Index and Fugl-Meyer assessment, sitting balance
Dependent: score on the Action Research Arm Test (ARAT) for the hemiplegic arm
function, tested at 72 hours, 5 and 9 days, and 6 months after stroke
Sampling and Study Population
Inclusion Criteria
After dropouts 156 subjects remained, 87 were female and 69 male, mean age was 66.47, 69 had left
sided stroke and 87 had right sided strokes.
Internal Validity
Measurements were standardized and performed by trained PTs or OTs in
stroke units
Assessors were given a training course and tested for interobserver
reliability
Patients all received treatment that followed the Dutch rehab guidelines
Results
70.5% of subjects had some dexterity (ARAT greater than or equal to 10) in the paretic arm
Finger extension in the Fugl-Meyer hand score and shoulder abduction in the Motricity Index arm
score within 72 hours, showed correlation with return to some dexterity at six months after stroke.
The probability was estimated to be 0.98 if they had these determinants and 0.25 if not. It also
applied for 5 and 9 days.
Also 60% of people who had voluntary finger extension reached the max ARAT score (full recovery)
and 48% who had voluntary shoulder abduction reached the maximum score. This is higher than
the 34% of the total.
The finger extension preservation could relate to the need of corticospinal tract fibers to be intact to
have control of distal arm and hand muscles. The shoulder abduction preservation could relate to the
need for proximal and distal segments to be neurally coupled for motor control (proximal stability for
distal mobility).
Summary Schematic
Future Research
Paige Trudeau
Effect of Gait Retraining on Balance, Activities of Daily Living, Quality of Life and
Depression in Stroke Patients.
Relevance:
Purpose:
This study investigated the effect of gait retraining on balance, activities of daily
living, quality of life and depression in stroke patients.
Design and Sampling
Blinding- All assessment in pre-test and post-test were done by a physiotherapist and interventions were done
by another therapist.
Random Assignment- No control group, so there was no random assignment into groups.
Protocol:
-The PNF mat activities included resisted pelvic and lower extremity movement patterns
Variables
-QoL (SF-36)
-Depression (BDI-II).
***This is significant as it shows that gait-retraining and PNF are able to not only
help patients regain physical function (Balance, ADLs) but also receive
psychological benefit (QoL, Depression.)
Weaknesses and Future Research
Weaknesses:
-Unable to decipher if gait training directly improved all four of these areas, or if improvement in one
area led to improvements in others (i.e. if improved ability to do ADLs decreased depression, not the gait
training itself)
-This was a convenience sample taken from area near researchers, decreasing generalizability to the
population as a whole. Small sample size of 18 also decreases generalizability.
Future Research:
-Identification of other therapy that can be used to improve these measures for patients who may not
ever become ambulatory.
Comparing the effects of rhythmic auditory cueing and
visual cueing in acute hemiparetic stroke
Swati Chouhan, Sanjiv Kumar MD., 2012
Ian Helsel
Relevance
Inclusion Exclusion
Patient Age
Conventional Therapy
Conventional plus rhythmic auditory stimulation
Conventional plus visual cueing
Dependent Variables
Score on Dynamic Gait Index (DGI) and Fugl Meyer Assessment (FM)
Methods
Group A (RAS + conventional)
Patients instructed to complete activities to the pace of metronome beat.
Patients walked 10m under the following conditions:
Their maximal speed on first day of study (baseline cadence)
Tandem walking, static marching, dynamic marching, walking in a
circle at speed of baseline cadence
RAS increasing baseline cadence by 10, increased every week
Last training session without RAS to check for learning.
Gross/Fine Motor
Patients instructed to move their fingers between two targets at
maximal self selected pace to get baseline
Move fingers and pick up different shaped objects in sync with RAS
Mat exercises, stretching, gait training
Methods
Group B (VC + conventional) Group C (Conventional)
Gait training for 2hr 3 x week for 3 weeks
Static marching, dynamic marching, tandem Stretching of tight musculature
walking, walking in circle AT exercises
picking up different colored objects of different Gait training
sizes and shapes
Picking up ball with stretched arm and move the
ball to the other end of the table or opposite hand
Picking up pen with proper grip technique
Results
Limitations
Future Research
Grace Blankenhagen
Relevance
- Strategies to encourage the return of sensation and awareness to his left side
will improve his prognosis
Schematic
Follow up assessment
Right hemisphere
Lesion (CVA) and 3 month
Hemisensory neglect waiting period
Teeva Carpenter-Smith
Relevance
R middle cerebral Artery CVA
No muscle function in the L shoulder
at risk for hemiplegia pain
No complaints of shoulder pain after CVA
Began receiving rehab within 10 days of CVA
Design and Variables
A single blind randomized controlled trial
3 groups:
Control
Placebo taping
Therapeutic taping
Primary outcome measure:
Ritchie Articular Index
Secondary outcome measures:
Shoulder ROM
Tone (modified ashworth scale)
Function (motor assessment scale)
Sampling and Population
Subjects were recruited from 3 clinics over a 2 year period in the
Metropolitan Melbourne (Australia)
Inclusion Criteria:
UE component of the Motor Assessment Scale score of 13 or less
low or no muscle function around the shoulder
No or minimal shoulder pain prior CVA
No shoulder pain after CVA
Presented to rehab within 3 weeks of CVA
No residual limb dysfunction from a previous CVA
Methods
Taping: strapping technique was based on that reported by Ancliffe
Skin prep, pad under axilla, lightweight adhesive tape, reapplied every 3-4 days
Placebo: anchor tape only
Control: no tape
All groups continued PT and OT treatments as prescribed
Measurements taken at beginning of Week 1 and after 4 weeks of treatment
Results
Number of pain-free days (out of 28):
Therapeutic Taping: 26.2 days
Placebo Taping: 19.1 days
Control Group: 15.9
No significant difference in number of days between therapeutic and
placebo groups.
Placebo group lost ROM in all directions
No change in muscle tone for any group
Weaknesses & Future Studies
Unknown if therapeutic effect is long term
Conner Bruns
Relevance to the Case
Pt has hemiplegia on his L side
This study looks at how utilizing task-oriented mirror therapy can help pts to
better regain function
Design and Variables
Randomized Control Trial
Independent Variables:
Age
Gender
Comorbidities
CVA type, hemisphere, and timing
Intervention group (Mirror or sham)
Dependent Variables:
Fugl-Meyer Motor Function Assessment (FMA) scores
Brunnstrom Motor Recovery Stage scores
Modified Barthel Index (MBI) scores
Sampling and Study Population
60 total subjects
Inclusion criteria:
Hemiplegia diagnosis due to stroke within 6 mo.
Score of 24 points or more on Korean version of Mini-Mental State exam
Brunnstrom stage of UE recover of 3-4
Exclusion Criteria:
Musculoskeletal disorder
Mental illness
Neglect
30 subjected to task-oriented mirror therapy (19 male, 11 female)
Avg Age = 65.3 years
Avg length of illness = 49.4 days
22 cerebral hemorrhage, 8 cerebral infarction
30 subjected to sham conventional therapy (20 male, 10 female)
Avg Age = 64.5 years
Avg length of illness = 53.7 days
19 cerebral hemorrhage, 11 cerebral infarction
Schematic
Methods
4 weeks of therapy for each group, 5x/wk
Mirror Therapy Group: 20 minutes of task-oriented mirror therapy,
attempting to move involved UE by imitating reflection of unaffected UE in
mirror
Wk 1: Flex/ext, sup/pron
Wk 2: Finger flex/ext, counting, tapping, opposing
Wk 3: Simple manipulative tasks such as picking up coins, flipping cards, organizing blocks
Wk 4: Pegboards, drawing, coloring
Sham Therapy Groups: Same as above, but with a wooden plate separating
the two UEs rather than a mirror
Fugl-Meyer Motor Function Assessment (FMA) and Brunnstrom stage were
used to assess function pre and post-intervention
Modified Barthel Index (MBI) used to assess ADLs pre and post-intervention
Results
Brunnstrom stage for both groups pre- and post- treatment did not differ
significantly.
FMA:
Mirror Therapy: 26.93+/-6.32 to 41.40+/-9.04
Sham Therapy: 26.90+/-6.32 to 37.40+/-9.04
MBI:
Mirror Therapy: 28.67+/-7.57 to 59.63+/-15.58
Sham Therapy: 26.77+/-6.60 to 51.37+/-16.34
Weaknesses