Stroke rehabilitation

Motor improvements in chronic stroke recovery accrue from coupled protocols of bilateral movements and active neuromuscular stimulation. This experiment investigated coupled protocols and within-limb transfer between distal and proximal joint combinations. The leading question focused on within-limb transfer of coupled protocols on distal joints to a bimanual aiming task that involved proximal joints. Twenty-six volunteers completed one of three motor

The increasing population of older people is leading to growing healthcare demands. Stroke is the commonest cause of severe disability in developed countries leaving one third of patients with long term disability. Rehabilitation is the cornerstone of recovery. Lack of rehabilitation manpower resources can limit recovery of limb function. However, technology can assist rehabilitation staff to deliver greater intensity of

Visual Neglect (VN) is a common neuropsychological deficit associated with a person having a stroke (approximately 1/3/ of cases). Visual neglect is characterised by an inability to notice things on the side contralateral to the stroke site, typically the left. Currently in the clinical setting, pen and paper-based techniques such as the Behavioural Inattention Test (BIT) and Star Cancellation are used to assess the presence of VN in patients but they are purely binary classifiers and lack sensitivity so may fail to pick up subtle neglect. Regarding rehabilitation, there have been a number of programs developed to try and ameliorate the symptoms of VN with limited/varying degrees of success. Using the Leap Motion Controller, the associated SDK and the Processing programming language, this project sets out to develop a novel measurement paradigm for the mapping the spatial distribution of visual neglect to give a more nuances assessment of severity. It also lays the groundwork for developing a novel rehabilitative intervention based on Visual Scanning and Limb Activation.

This study aims to detect the efficacy of a modified complete decongestive therapy program on the improvement of the circumferential measures of the lymphedematous limbs. A prospective observational and interventional study; twenty-six patients with unilateral lymphedema of the extremities both primary and secondary were enrolled. All patients were treated with 6 sessions of complete decongestive therapy on a two-phase program. The first phase consists of meticulous skin care, manual lymphatic drainage, exercises and compression bandages. Phase 2 of self-care program. Circumferential measures of the affected limb were taken as an outcome measure; recorded before and 12 weeks after the application of the decongestive therapy. In both, primary and secondary lymphedema, the modified complete decongestive therapy resulted in a significant reduction (p < 0.05) in the circumference of the affected limb. The circumferential measures of the involved limbs after treatment were (79.69 ± 11.92) and (107.68 ± 24.98), consecutively: comparative to the pretreatment measures of (85.14 ± 7.48) for the upper limbs and (113.71 ± 26.91) for the lower limbs. In conclusion, application of a complete decongestive therapy, per available recourses, in a short course or a modified regimen can help in treating primary and secondary lymphedema of the extremities.

Levy CE, Nichols DS, Schmalbrock PM, Keller P, Chakeres DW:
Functional MRI evidence of cortical reorganization in upper-limb stroke
hemiparesis treated with constraint-induced movement therapy. Am J
Phys Med Rehabil 2001;80:4–12.
Objective: The purpose of this pilot study was to test constraint-induced
movement therapy for chronic upper-limb stroke hemiparesis and to investigate
the neural correlates of recovery with functional magnetic resonance
imaging (MRI) in two subjects. Both subjects had been discharged from
traditional therapy because no further improvement was anticipated.
Design: Constraint-induced movement therapy consisted of 6 hr of
daily upper-limb training for 2 wk; a restrictive mitt was worn on the
nonparetic limb during waking hours. Functional MRI was performed
on a 1.5-T MRI with echo-planar imaging; at the same time, the subjects
attempted sequential finger-tapping.
Results: Compared with baseline, performance time improved an average
of 24% immediately after training and also continued to improve up to
33% 3 mo after training. Lift, grip strength, and Motor Activity Log scores
likewise improved. Initially, on functional MRI, subject 1 activated scattered
regions in the ipsilateral posterior parietal and occipital cortices.
Subject 2 showed almost no areas of significant activation. After training,
subject 1 showed activity bordering the lesion, bilateral activation in the
association motor cortices, and ipsilateral activation in the primary motor
cortex. Subject 2 showed activation near the lesion site.
Conclusion: Constraint-induced movement therapy produced significant
functional improvement and resulted in plasticity as demonstrated
by functional MRI.
Key Words: Stroke, Constraint-Induced Movement Therapy, Functional
Magnetic Resonance Imaging, Plasticity

AIM: To evaluate the effect of individualized resting mitt splints on hypertonicity (spasticity and tissue stiffness) and passive range of motion (PROM). METHODS: A randomized, single blinded, single case design. Ten adults with acquired brain injury were randomized to control (no-splint) and experimental (splint) groups. The experimental group received an individualized (wrist position, wearing schedule) thermoplastic resting mitt splint. Measures included wrist and finger PROM, muscle stiffness (Modified Ashworth Scale), and spasticity (Modified Tardieu Scale) which were taken at five time points. RESULTS: Between-group analyses indicated a statistically significant effect on PROM at the wrist (d = 2.14, CI 95 = 0.57, 3.72, p < 0.05) and clinically important effects on finger PROM, and wrist and finger spasticity and stiffness. Within-group analyses indicated that splint-wear resulted in positive clinical effects ranging from zero effect (maintenance of pre-splinting status) to a large positive treatment effect. Non splint-wear resulted in negative clinical effects ranging from zero effect to a large negative treatment effect. CONCLUSION: Individualized resting splints for adults with moderate hypertonicity and no soft tissue contracture resulted in positive clinical effects to PROM, muscle stiffness and spasticity. Long-term splint-wear may be more beneficial than short-term wear, and may prevent the negative changes evident with no splint-wear. Resting hand splints should be considered for a select group where reduction in muscle stiffness and spasticity, or maintenance of PROM, is desired.

People with stroke or Parkinson&#39;s disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options...

Aim: To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture. Methods: Sixty-four intervention decisions (including strength/movement training, splinting and/or casting) were drawn retrospectively from initial reports at a community clinic. Associations between identified upper limb characteristics, stated clinical aims and intervention decisions were analysed using logistic regression. Results: Casting was statistically significantly likely to be chosen in the presence of moderate (CI95 1.88–39.80, p = 0.01) or severe hypertonicity (CI95 1.34–135.98, p = 0.03), and if the stated clinical aim was to reduce hypertonicity (CI95 2.01−18.10, p = 0.001) or contracture (CI95 1.31–12.73, p = 0.02). When reports included both these clinical aims, there was a highly significant association with the decision to cast (CI95 5.67–9.13, p = 0.001). Where casting was indicated as appropriate, but not chosen as an intervention, mitigating factors included older age (70–95 years), limited personal support and a clinical aim of comfort/hygiene maintenance. Conclusion: Occupational therapists using the Protocol consistently chose casting as an upper limb intervention for adults who demonstrated moderate/severe hypertonicity, contracture or limited functional ability. Prospective research is required to determine intervention outcomes following use of the Protocol.

Stein J, Shafqat S, Doherty D, Frates EP, Furie KL: Family member knowledge and expectations for functional recovery after stroke. Am J Phys Med Rehabil 2003;82:169 –174. Objective: To assess the stroke knowledge and expectations for recovery among the family members of stroke patients in an acute rehabilitation hospital. Design: Survey study of 50 family members of stroke patients undergoing inpatient rehabilitation at a single urban rehabilitation hospital. Results: Sixty percent of participants were able to identify whether their family member had sustained a cerebral hemorrhage or infarct; 48% were able to identify at least one treatment provided to their family member for his or her stroke. The average length of stay predicted by participants closely matched the average patient length of stay. Participants tended to overestimate the functional abilities of their family member with a stroke, both on initial assessment and discharge. This overestimation was more substantial for discharge functional ability than for initial assessment. Participants were able to predict discharge location with substantial accuracy (82% agreement, kappa 0.41). Conclusions: The knowledge of stroke etiology and functional outcome of family members of individuals undergoing rehabilitation after stroke shows significant limitations. Participants' ability to predict functional outcome on discharge was worse than their knowledge of current functional status. Participant predictions of length of stay and discharge disposition were areas of relative strength. Further efforts are needed to enhance the knowledge level of family members of patients undergoing rehabilitation after stroke.

This report evaluates the impact of live music in two hospitals in Nottingham, UK, as provided by Wellspring Music CIC. Observations and surveys showed positive responses among patients, which were also in line with what staff and visitors reported. The staff reported increased wellbeing as a result of the music sessions, and similar patterns were found among visitors and family members. The results suggest that music can create a space for patients in hospital to interact, connect and ease their anxiety and stress, and that such music activities can also support healthcare staff in their working environment by providing entertainment, relaxation and help bringing a level of normality and everyday life into the hospital wards.

The purpose of this study was to assess the performance of a real-time (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;open-end&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;) version of the dynamic time warping (DTW) algorithm for the recognition of motor exercises. Given a possibly incomplete input stream of data and a reference time series, the open-end DTW algorithm computes both the size of the prefix of reference which is best matched by the input, and the dissimilarity between the matched portions. The algorithm was used to provide real-time feedback to neurological patients undergoing motor rehabilitation. We acquired a dataset of multivariate time series from a sensorized long-sleeve shirt which contains 29 strain sensors distributed on the upper limb. Seven typical rehabilitation exercises were recorded in several variations, both correctly and incorrectly executed, and at various speeds, totaling a data set of 840 time series. Nearest-neighbour classifiers were built according to the outputs of open-end DTW alignments and their global counterparts on exercise pairs. The classifiers were also tested on well-known public datasets from heterogeneous domains. Nonparametric tests show that (1) on full time series the two algorithms achieve the same classification accuracy (p-value =0.32); (2) on partial time series, classifiers based on open-end DTW have a far higher accuracy (kappa=0.898 versus kappa=0.447;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10(-5)); and (3) the prediction of the matched fraction follows closely the ground truth (root mean square &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10%). The results hold for the motor rehabilitation and the other datasets tested, as well. The open-end variant of the DTW algorithm is suitable for the classification of truncated quantitative time series, even in the presence of noise. Early recognition and accurate class prediction can be achieved, provided that enough variance is available over the time span of the reference. Therefore, the proposed technique expands the use of DTW to a wider range of applications, such as real-time biofeedback systems.

Keane S, Turner C, Sherrington C, Beard JR. Use of Fresnel prism glasses to treat stroke patients with hemispatial neglect.To explore the functional effects of prism adaptation training on patients with hemispatial neglect after stroke.Observational study.Inpatient rehabilitation unit in rural Australia.Four subjects with hemispatial neglect, recruited from consecutive admissions of patients less than 60 days poststroke.Prism adaptation treatment, consisting of five 10-minute training sessions over 12 to 17 days.The FIM instrument, Catherine Bergego Scale (CBS), subjective straight ahead pointing, Albert’s line cancellation, letter cancellation, and line bisection. Ambulatory patients also performed the Timed Up & Go test.Immediate effects of prism adaptation training included improvements in both subjective straight ahead pointing and in the Albert’s line cancellation task. Letter cancellation, line bisection, FIM, and CBS scores improved in all subjects. Improvements in a functional task were also observed immediately following prism adaptation treatment. Obstacle avoidance while walking improved after prism adaptation training in 2 ambulatory subjects.Prism adaptation training shows promise as a new treatment to supplement current strategies for the clinical management of hemispatial neglect after stroke. This study is limited by small sample size and absence of a control group. Further research will be needed to demonstrate efficacy for this inexpensive and relatively safe device.

The Stroke Rehabilitation Assessment of Movement (STREAM) instrument is used to measure motor and mobility problems in patients who have experienced a stroke. The purposes of the study were to examine the interrater reliability, concurrent and convergent validity of the STREAM instrument in stroke patients. Fifty-four stroke patients participated in the study. For the purpose of interrater reliability, the STREAM instrument was administered by two raters on each patient within a 2-day period. Validity was assessed by comparing the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; scores on the STREAM instrument with those obtained from the other well-established measures. Weighted kappa statistics for inter-rater agreement on scores for individual items ranged from 0.55 to 0.94. The intraclass correlation coefficient for the total score was 0.96 indicating very high inter-rater reliability. The intraclass correlation coefficients were also very high in each of the subscales. The total STREAM score was moderately to highly associated with the score of the Barthel Index and Fugl-Meyer motor assessment scale, rho = 0.67, and 0.95, respectively. The STREAM subscale scores were closely associated with scores of the other well-validated measures. Our results demonstrate that consistent and valid information can be obtained from the STREAM instrument and support its use in the value of the STREAM evaluation of motor and mobility recovery in persons who have experienced a stroke.

More than 2 million people in the United States are unable to speak or use handwriting as an effective and efficient mean of communication (ASHA,2004). This paper discusses a brief history of augmentative alternative communication (AAC) devices. The ultimate goal of an AAC intervention is to enable individuals to efficiently and effectively engage in a variety of interactions. Communication is a critical element of staying connected to society and is the tool for redefining one’s self. This paper discusses the history of AAC, as well as etiologies that may benefit from AAC use. Without access to speech, individuals are severely restricted within communication and participation in all aspects of life. Furthermore, new mobile technology such as the iPad has brought AAC into the mainstream. The iPad and other mobile technologies provide powerful new tools to potentially enhance communication for individuals with developmental disabilities, acquired neurogenic disorders, and degenerative neurological conditions. A brief comparison between today's mobile technologies and traditional AAC devices such as the Picture Exchange Communication System (PECS) and the Voice Output Communication Device (VOCD) proves which speech generating device (SGD) is more beneficial to individuals that require AAC.


Keywords: Augmentative alternative communication; Picture Exchange Communication System; Voice Output Communication; Speech Generating Device; iPad; Mobile technology

Special issue of "Culture Unbound". Through an introduction and six original articles, the issue investigates a variety of cultural and scientific discourses and practices that in different ways are related to neuroscience and the brain.

The special issue was edited by guest editors Peter Bengtsen and Kristofer Hansson.