ASSESMENT to improved movement control of the impaired

ASSESMENT OF LIMBS IN THE STROKE
PATIENTS

A stroke is a brain attack similar to a
heart attack, and is mostly caused by a blockage of a blood vessel to part
of the brain, the symptoms of the stroke occurs in the manner of weakness
of Face, weakness of Arms, impaired  Speech,
loss of vision, loss of consciousness. since weakness of arms affects the day
to day activities  which make  even harder for the  affected 
persons, this article going to discuss about the assessment method used
for the improvement of the upper limb functions.   

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Bilateral and unilateral movement
training on upper limb function in chronic stroke patients:

Currently
there is great interest in rehabilitation-induced recovery of motor function in
chronic stroke patients motor cortex function in patients with chronic
impairments can be altered by the motor experiences of the individual encouraging
use of the hemiplegic limb through activity dependent interventions has
evidenced some success in expediting progress toward recovery of upper limb
function.

An
alternative approach, known as bilateral movement training (BMT), uses the
intact limb to promote functional recovery of the impaired limb through the
facilitative coupling effects between the upper limbs identified in studies of
interlimb coordination in healthy adults. The practice of bilateral symmetrical
movements may allow the activation of the intact hemisphere to facilitate the
activation of the damaged hemisphere leading to improved movement control of
the impaired limb promoting neural plasticity. The results of the few studies
investigating Bilateral Movement Training

The use of
activity-dependent interventions has shown some success in promoting recovery
of upper limb function in chronic stroke patients. This study compared the neurophysiologic
and behavioural changes associated with two such rehabilitation protocols:
unilateral and bilateral movement training. Twelve chronic stroke patients were
randomly assigned to the two training protocols involving six daily practice sessions.
Each session consisted of 50 trials of a dowel placement task performed either
with both impaired and unimpaired arm moving synchronously (bilateral training
group) or with only the impaired arm moving (unilateral training). Kinematic
measurements of upper limb movements were made in four unilateral test trials
performed prior to and following each practice session. Functional assessments
of the impaired upper limb and neurophysiological assessments, using
transcranial magnetic stimulation (TMS), of the affected and nonaffected
cortical hemispheres were made prior to and following the intervention
sessions. Individuals receiving bilateral training showed a reduction in
movement time of the impaired limb and increased upper limb functional ability
compared to individuals receiving unilateral training. In some patients changes
to upper limb function were associated with changes to the cortical
representation of a target muscle in the non-affected hemisphere. Overall,
these findings suggest that a short-term bilateral training intervention may be
effective in facilitating upper limb motor function in chronic stroke patients.

 

Arm rehabilitation in post stroke subjects: A randomized controlled
trial on the efficacy of myoelectrically driven FES applied in a task-oriented
approach

Motor recovery of persons after stroke may be enhanced by a
novel approach where residual muscle activity is facilitated by
patient-controlled electrical muscle activation. Myoelectric activity from
hemiparetic muscles is then used for continuous control of functional
electrical stimulation (MeCFES) of same or synergic muscles to promote
restoration of movements during task-oriented therapy (TOT). Use of MeCFES
during TOT may help to obtain a larger functional and neurological recovery
than otherwise possible.

MeCFES can be a safe adjunct
to rehabilitation that could promote recovery of upper limb function in persons after stroke, particularly when applied in the subacute phase

Effect of Scapular Stabilization
Exercise during Standing on Upper Limb Function and Gait Ability of Stroke
Patients

 

scapular
stabilization exercise during standing on a paretic side on upper limb function
and gait ability of stroke patients

Many stroke
patients cannot use their impaired upper limb properly despite long-term
intensive therapy because damage to the upper limb after stroke is one of the
most common and severe stroke side effects. The hand function of the upper limb
is the most highly damaged one in brain-damaged patients. This is because betz
cell is the most abundant cell in the cerebral cortex. It is responsible for
the control of hand. Adjustment to a specific pattern is required for segments
between the neck and the body to maintain the stability of the upper body
during walking

However, the
effects of scapular stabilization exercise during standing on a paretic side on
gait ability of hemiplegic patients after stroke remain unclear. Therefore, the
study was conducted  to determine the
effects of scapular stabilization exercise during standing on a paretic side on
the gait ability of hemiplegic patients after stroke . Results of the study
indicated that scapular stabilization exercise during standing on a paretic
side for 8 weeks had an effect on the gait ability of hemiplegic patients after
stroke.

Quantitative assessment
test for upper-limb motor function by using EMG and Kinematic Analysis in the
practice of Occupational Therapy.

Stroke causes functional disorders of the brain by
hemorrhage or infarction.  The number of
stroke patients are growing because the survival rate of acute stroke has been
increased. The purpose of rehabilitation of stroke is to improve motor ability to
recover their activities of daily living (ADL), not to go back to the
original state before the stroke. Most of the strokes  are associated with upper limb function. 85%
of acute patients have the upper limb disorders. 55~75% of patients after the
onset of 6 months still have a problem in the upper limb function. The basic
principle of rehabilitation for stroke patients is brain plasticity based on
repeatability and task orientation. Task-oriented exercise aiming at specific
movement is more effective . There are many therapies to recover motor function.
It includes the exercise training under the mediation of the therapist,
physical therapy to provide mechanical stimulation such as functional
electrical stimulation and orthosis and occupational therapy (e.g., moving the
cup and hanging on a hanger) It is important to understand accurately about the
patient’s functional status to provide appropriate treatment strategies. 

                                            
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Pattern of improvement in upper
limb pointing task kinematics after a 3-month training program with robotic
assistance in stroke

 

When exploring
changes in upper limb kinematics and motor impairment associated with motor
recovery in  subacute post stroke during
intensive therapies involving robot-assisted training, it is not known whether
trained joints improve before non-trained joints and whether target reaching
capacity improves before movement accuracy.

An intensive
rehabilitation program combining robot-assisted shoulder/elbow training and
conventional occupational therapy was associated with improvement in shoulder
and elbow movements first, which suggests focal behavior-related brain
plasticity. Findings also suggested that recovery of movement quantity related
parameters (range of motion, velocity and smoothness) might precede that of
movement quality (accuracy).

Following stroke,
70 to 90% of patients report residual motor impairment in their paretic upper
limb, affecting daily activities and quality of life.

 use of robotic devices in spastic paresis
helps deliver high dosages of physical treatment, based on high number
repetition of goal-directed tasks in an interactive environment . A number of
controlled clinical trials have suggested positive effects of robot-assisted
training programs, applied in complete or partial substitution of or in
adjunction to conventional occupational therapy, on upper limb function in
subacute and chronic stroke . Overall, greater motor improvements were reported
with robot-assisted training programs when compared with conventional therapy
programs ,except when a matched intensity level of exercise was used in manual
therapy, which is unusual or difficult in conventional rehabilitation .

In addition to
potentially enhancing motor improvement after stroke, robotic devices comprise
goniometers and sensors of position, force and stiffness, and thus can provide
immediate, reliable and continuous measurements of the movements performed
during the training sessions #During an intensive 3-month upper limb rehabilitation
program combining robot-assisted shoulder-elbow training and conventional
rehabilitation care initiated two months following stroke in patients with
severe residual motor deficit, proximal before distal motor improvement was
observed. In addition, active range of motion and velocity improved before
movement accuracy. These findings suggest that a rehabilitation program with
large amounts of daily repetitive active movements over a prolonged duration
may stimulate brain plasticity, toward the specifically trained parts of the
upper limb first.

 

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