JRRD tipsheet: Focus on stroke, Parkinson's treatment, wheelchair durability

Rehabilitation

Chronic stroke patients benefit from robotic upper-limb rehabilitation, pg. 717
Intense, short-term, upper-limb robotic therapy improved motor outcomes among chronic stroke patients. Investigators enrolled 30 patients with upper-limb impairment due to stroke. Over 3 weeks, 18 sessions of robot-assisted therapy were delivered with the use of a robotic exercise device. Significant improvements were observed for severely impaired participants, which indicates that improvement is not limited to individuals with moderate impairments. Moderately and severely impaired patients tolerated intense, frequent, and repetitive treatment. This information is useful for determining the optimal target population, intensity, and duration of robotic therapy and the necessary sample size for a larger trial.

Robotics and functional neuromuscular stimulation improve arm/hand use following stroke, pg. 723
Stroke patients improved functional use of their impaired arms and hands by participating in robotics plus motor learning or neuromuscular stimulation plus motor learning. Investigators randomly assigned patients with chronic stroke to one of two treatment groups: robotics with motor learning (ROB-ML) or functional neuromuscular stimulation with motor learning (FNS-ML). All participants received treatment 5 hours a day, 5 days a week for 12 weeks. Results showed that ROB-ML participants had gains in functional tasks, accuracy, and smoothness of movement. FNS-ML participants had gains in upper-limb coordination and hand/wrist function.

Narrative discourse evaluation identifies subtle changes in language poststroke, pg. 737
Researchers used narrative discourse to identify patients experiencing language difficulties poststroke. A cohort of individuals who had experienced a left-hemisphere stroke and had not been diagnosed with a language disorder were evaluated for narrative discourse cohesiveness at 1, 6, and 12 months poststroke. Data indicate that during the first year poststroke, the average number of cohesive ties in narrative discourse remained constant, while the percentage of correct use of cohesive ties increased significantly during. These findings suggest that subtle disruptions in expressive language can be present initially but are recovered naturally over time.

Coping resources improve quality of life for caregivers of stroke survivors, pg. 747
Coping ability is the most important influence on the quality of life for stroke caregivers. Investigators examined data collected at 1 and 6 months poststroke to determine the influence of stroke survivor and caregiver characteristics on quality of life (QOL) for stroke caregivers. At both time points, the most influential factor was sense of coherence (SOC). SOC is the caregiver's ability to mobilize coping resources during periods of stress. Caregivers who effectively mobilized these resources experienced less burden and fewer symptoms of depression.

Walking increases bone density following stroke, pg. 761
Daily walking and ground reaction forces can potentially modulate bone loss in stroke survivors with impaired walking ability. Demographics, functional outcomes, bone mineral density (BMD), and gait-related parameters were evaluated in 33 volunteers with poststroke walking deficits. BMD at the hip was significantly lower on the impaired side. Investigators also found a relationship between BMD and a newly developed gait-related parameter that incorporates the number of steps per day and ground reaction force (the reaction to the force the body exerts on the ground). These findings stress that walking is an important component of rehabilitation for maintaining lower-limb bone density in persons with poststroke walking deficits.

Constraint-induced movement therapy improves recovery of upper-limb function following traumatic brain injury, pg. 769
Constraint-induced therapy may improve upper-limb motor function following chronic traumatic brain injury. A group of 22 participants with chronic traumatic brain injury and upper-limb paralysis participated in constraint-induced movement therapy for 2 weeks. Treatments included massed practice, shaping of the more-affected upper limb, behavioral contracts, and other behavioral techniques for affecting transfer to a real-world setting. Significant improvement was seen in participants' use of the more affected upper limb to accomplish activities of daily living.

Multidisciplinary treatment program improves long-term outcomes of individuals with Parkinson's disease, pg. 779
Over 75 percent of patients with Parkinson's disease (PD) enrolled in a multidisciplinary rehabilitation program demonstrated stable or improved motor function scores up to 3 years following treatment. Patients' disease progression was measured at baseline and 1, 2, or 3 years follow-up with the motor subscale of the Unified Parkinson's Disease Rating Scale. Multidisciplinary interventions included neurology, physiatry, nursing, psychology, medication changes, rehabilitation therapies, functional diagnostic testing, support group, home exercise instruction, and disease and wellness education. This is the first long-range study to assess the efficacy of a multidisciplinary clinical program in management of PD patients.

Muscle vibration may enhance controlled movement in people with central motor disorders, pg. 787
This study examined whether muscle vibration enhances the brain's ability to control voluntary movement. Sixteen healthy men and women participated in studies involving the application of 15 or 30 minutes of vibration to the wrist extensor muscle. Fifteen minutes of vibration significantly increased muscle twitch responses, which indicates increased output to the muscles. The effects of muscle vibration were not sustained after 20 minutes. These data provide a basis for exploring the effectiveness of muscle vibration in improving muscle function in people with central motor disorders such as stroke.

Rigid pylons as effective as shock-absorbing pylons for absorbing gait impact, pg. 795
Shock-absorbing pylons (SAP) are as effective as rigid pylons for people with below-the-knee amputations. In this study, a commonly prescribed SAP is compared to a conventional rigid pylon. The pylons were assessed for effect on gait mechanics, transmitted accelerations, and functional outcomes using step counts and questionnaires. The only statistically significant finding was for the prosthetic-side knee angle at initial contact. Volunteers displayed an average of 2.6 more flexion with the rigid pylon than the SAP while walking at a controlled speed. This result indicates that individuals with below-the-knee amputations can adjust the stiffness of their residual limb in response to changes in prosthetic component stiffness.

Foot and ankle ligament geometry, pg. 809
Little is known about how conditions such as diabetes affect the ligaments of the foot and ankle. In this study, researchers developed a new technique to determine the cross-sectional ligament area for a broad range of foot and ankle ligament sizes and shapes. The technique detailed in this study, together with its baseline data, will expand knowledge of foot ligament properties and foot function, and contribute to the development of a model that can be used in studies of conditions associated with foot deformity.

New insight may help avoid unnecessary hand surgery in elderly, pg. 821
Motor nerve conduction is a common clinical test used to diagnose nerve problems such as carpal tunnel syndrome. Current techniques use a single recording site over a superficial muscle. This approach does not take into account the electrical contributions from the other muscles innervated by the nerve being stimulated. This study recorded 15 sites over the thenar eminence (muscles at the base of the thumb) during motor nerve conduction studies. Data suggest that standard nerve conduction studies in elderly patients with a common arthritic change in the thumb may result in unnecessary hand surgery.

Neurocognitive enhancement therapy improves work outcomes for people with schizophrenia, pg. 829
In a recent study, neurocognitive enhancement therapy (NET) significantly improved work outcomes in 145 volunteers with schizophrenia or schizoaffective disorder. Study patients were randomly assigned to 6 months of paid work therapy (WT) or to NET plus WT. Volunteers receiving NET along with WT worked more hours than volunteers receiving WT only. These differences emerged after rehabilitation. Volunteers assigned to the NET plus WT group worked the most during follow-up and tended to have more competitive-wage employment.

New hearing loss test cuts clinical evaluation by half, pg. 839
Investigators developed a test that quickly measures speech understanding in background noise. An established 70-word hearing test was reduced to 35 words, which cut testing time in half. A shorter word list will help clinicians rapidly evaluate patients' abilities and address their needs (e.g., hearing aids with directional microphones, FM technology, or digital signal-processing noise-reduction algorithms).

Wheelchair durability and user satisfaction, pg. 853
A pilot study found that users of wheelchairs are generally satisfied with their mobility devices. A convenience sample of 130 participants who use wheelchairs as their primary means of mobility was recruited. Participants completed a questionnaire about their wheelchair, its maintenance and repair history, and their satisfaction levels. Results showed that 26 percent of participants had completed wheelchair repairs in the past 6 months, 16 percent had completed general maintenance, and 27 percent had completed tire repairs. Neither hours of wheelchair use nor wheelchair age affected repair or maintenance frequency. Better understanding of wheelchair maintenance and repair issues will guide improvements in wheelchair design and enhance the community participation of individuals who use wheelchairs.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
    Published on PsychCentral.com. All rights reserved.

 

 

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