Международный журнал нейрореабилитации

Background
Purpose: To examine the feasibility and effect of a virtual reality - based dance training paradigm in improving balance control and physical activity levels.
Method: Community-dwelling individuals with hemiparetic stroke (N=11) received a virtual reality - based dance paradigm for 6-weeks using the commercially available Kinect dance video game “Just Dance 3”. The change in balance control was evaluated by the Limits of Stability test (Neurocom Inc.). The post-training changes in self-initiated center of pressure response time (RT), the movement velocity (MV), the maximum excursion (MXE) were examined. Changes in physical activity during dance training were assessed using Omran HJ-321 Tri-Axis Pedometer. The gaming scores were recorded from the Kinect software after each game (during training).
Result: Post-training the RT was significantly reduced (pre vs. post, p<0.05). Similarly, post-training, MV and MXE were significantly higher (p<0.05). Number of steps during dance intervention significantly increased from the 1st to the 20th session (p<0.05).
Conclusion: Results validate the feasibility of this short duration high-intensity protocol for improving balance control and physical activity in chronic stroke survivors.

Background and aim: Trials have shown modest clinical improvement in disabilities after stroke with the use of different techniques; however most of the treatment protocols for the paretic hand are either expensive or labour intensive, which makes the provision of intensive treatment for many patients difficult. Mirror therapy (MT) is an alternative therapeutic intervention that uses the interaction of visuomotor-proprioception inputs to enhance movement performance of the impaired hand. It has been suggested that mirror therapy is a simple, inexpensive and, most importantly patient-directed treatment that may improve hand function. The aim of this pilot study was to assess the effectiveness of Mirror Therapy to improve hand functions in acute and sub-acute stroke patients.
Method: In a pre-test-post-test single-group design, a convenience sample of 11 of acute and sub-acute stroke patients at Department of Physiotherapy, in Pad. Dr. Vikhe Patil Hospital, Ahmednagar. Participants received a Mirror Therapy program, performing various movements by the less affected upper extremity and observing in the mirror box along with conventional management, 4 days per week for 4 weeks. Fugl-Meyer Assessment (FMA), which includes subsection hand (FMA-WH), Wolf Motor Function Test (WFMT-WH) were used as an outcome measure.
Results: Participants showed significant improvement for FMA-WH and WFMT-WH at post assessment. WFMTWH changed from 7.545 to 15.727. (p=<0.0001) whereas FMA-WH changed from 34.18 to 47.36. (p=0.0002).
Conclusion: The preliminary findings suggest that Mirror therapy can be a useful intervention supplement in rehabilitation of patients; it provides a simple and cost effective therapy for wrist and hand motor recovery in acute and sub-acute stroke patients. Further studies in the form of randomized trials are needed to validate its effectiveness.

Background and purpose: Discharge status and acute re-hospitalization are used as indicators of stroke severity and recovery. Intravenous t-PA (tissue plasminogen activator) is one of two treatments shown to have a positive impact. Stroke rehabilitation patients are an important population who will end up integrated back into the community, institutionalized or hospitalized due to late stroke complications. We sought to determine factors contributing to post rehabilitation discharge and acute re-hospitalization, in particular, the impact of t-PA therapy.
Methods: Retrospective analysis of census data from ischemic stroke patients on the UTHealth Stroke/ Neurorehabilitation Services at Memorial Hermann Hospital - Texas Medical Center between Jan 2011 and Nov 2013, discharged to the Community, SNF (Skilled Nursing Facility) or AC (Acute Care). Demographics and NIHSS (National Institutes of Health Stroke Scale) were collected. Discharge FIM (Functional Independence Measure) was the reference standard. Genitourinary infections were a negative mediator in the multivariate regression.
Results: Of 346 patients, 274 returned to the community, 47 to SNF, and 25 to AC. NIHSS and t-PA therapy: Median NIHSS values were 8 in the community group, 11 in SNF and 9.5 in AC. 31.8% of patients received IV t-PA in the community group, 23.4% in SNF and 24% in AC. There were no statistically differences in community discharge rates. Community vs. AC: One day increase in rehabilitation hospitalization correlated with 19% decreased odds of AC readmission (OR 0.81; P=0.001).One unit discharge FIM increase correlated with 13% decreased odds of AC readmission (OR 0.87; P=0.003). Community vs.
SNF: One year age increase correlated with 4% increased odds of SNF admission (OR 1.04; P=0.02). Conclusions: Intense rehabilitation evidenced by FIM improvement and length of stay, impacts community discharge in mild to moderate stroke patients. t-PA had no effect. This study is limited by sample size, retrospective design and undetermined psychosocial factors.

Onset of action, duration and maximum efficacy of different botulinum toxin type A (BoNT/A) preparations have been compared mainly in in vitro studies. This single-center open study compared onset of action of the two BoNT/A preparations onabotulinumtoxinA (complex size 900 kDa) and incobotulinumtoxinA (free of complexing proteins, 150 kDa) in patients with spasticity after cerebral stroke over a 15-day treatment period. Outcome measures were changes in muscle tone, increase in passive extension of the elbow, changes in limb functionality, and variation of the amplitude of the compound muscle action potential (cMAP) determined by electroneurography. A total of 108 patients (mean age 64.8 ± 11.3 years) were included in the study, 54 in each treatment arm. Muscle tone, elbow motion range, and limb function significantly improved in both groups from baseline to day 15 after BoNT/A injection (p<0.0001). Improvements were significantly greater under incobotulinumtoxinA compared to onabotulinumtoxinA after 7 treatment days (p<0.0001) but were comparable after 15 days. Regarding cMAP amplitude, a faster reduction in the first 7 treatment days with no further significant reductions during the next week was observed for in cobotulinum toxinA patients, whereas on a botulinum toxinA patients showed a slower, progressive reduction in action potential resulting in comparable values between the two groups after 15 days. Overall, the efficacy of both BoNT/A preparations was comparable two weeks after injection.

Background: The progressive motor dysfunction and cognitive impairment associated with mid- to late-stage Huntington Disease (HD) renders few exercise programs amenable for use in this population. Exercise may slow the symptomatic progression of HD, therefore appropriate programs should be available to those with advanced disease. The pool, with a low risk of falling, boasts an appropriate environment to support choreic limbs. The purpose of this qualitative questionnaire-based study was to assess the feasibility and safety of aquatherapy in mid- to late-stage HD, and program perception by participants/caregivers.
Methods: Six participants with manifest HD completed a six-week aquatherapy program comprised of twiceweekly sessions. Participant-tailored aquatherapy sessions involved a warm-up, exercise-set, and a cool-down. Study notes regarding injury and compliance were recorded to track measures of safety and feasibility. Participants (and caregivers where available) gave an interview following the program. Conversations were audio recorded and fully transcribed. Interviews were analyzed to extract themes.
Results: Generally, participants reported the aquatherapy to be enjoyable, feasible, and safe, as well described improved mood, sleep, and quality of life. Anecdotal evidence suggests that many participants experienced improved physical conditioning.
Conclusions: Twice-weekly aquatherapy is feasible in mid- to late-stage HD, and was perceived to be safe and enjoyable.

Aim: A hold relax technique of Proprioceptive Neuromuscular Facilitations and Static Stretching were used to improve gait parameter in hemiplegic patients.
Methodology: A total of 30 patients were selected. Interventions were given for three times per day for six days in a week for four weeks, which consisted of hold relax technique of Propriceptive Neuromuscular Fascilitation or Static Stretching of knee extensors and ankle plantar flexors muscle of hemiplegic stroke patients.
Results: T test was applied, mean ± standard deviation of each group was compared and the P value was taken less than 0.05 for significant differences.
Conclusions: There was significant differences in the gait parameter (stride length, cadence and walking velocity) between two groups A & B treated with hold relax technique of Proprioceptive Neuromuscular Facilitation and Static Stretching.

Stroke is the second most common cause of death and major cause of disability worldwide. Hand motor dysfunction is a common impairment in stroke patients, as the cortical projection area of our fingers is large. Once it is damaged, it will be very difficult to restore the function, and has long been the focus and difficulty of stroke rehabilitation. Music- supported therapy in recent study was shown to induce improvements in motor skills in stroke survivors.
Objective: This study aimed at assessing the motor recovery of the affected hand induced by music-supported therapy in chronic stroke patients.
Methods: 14 patients with subcortical stroke, mild to moderately impaired hand function fulfilling the inclusion criteria were randomly assigned to the music group and control group. Both groups received keyboard (Yamaha) training for 30min, 20 times over 4 weeks in addition to conventional treatments. And the only difference between the two groups was that control group’s keyboard could not make any sound. They were trained in an intensive step by step training program. Patients were assessed by Wolf Motor Function Test before and after training.
Results: Both groups showed improvement in motor function assessed by Wolf Motor Function Test scores, and the improvement in music group was significantly better than that of the control group. Conclusions: The music-supported training with sound can enhance the restoration of hand function much better than the training with no sound in which the music played an important role.