3,199 research outputs found

    An Experimental study on Effectiveness of Functional Electrical Stimulation to Improve Functional Mobility and Balance among Subjects with Sub Acute Ischemic Middle Cerebral Artery Stroke: A Double Blinded Randomized Study

    Get PDF
    INTRODUCTION: The cerebrovascular accident is one of the leading causes of mortality and morbidity in worldwide. According to the WHO 2012, about 56 million global deaths were estimated, on that 38 million or 68% were due to non-communicable diseases (NCDs). The leading causes of NCD deaths were cardiovascular disease (46% of all NCD deaths), which included an estimated 7.4 million deaths due to coronary heart disease and 6.7 million deaths due to cerebrovascular accident or stroke. METHODOLOGY: Based on the selection criteria 24 patients with sub-acute ischemic middle cerebral artery stroke were selected for this study and they were divided into two group by using concealed envelop method. Subjects in control group (Group A) received body weight supported treadmill training. Subjects in experimental group (Group B) received body weight supported treadmill training along with functional electrical stimulation therapy. Both the groups were received intervention for 30 minutes per session, 6 days in a week for 6 weeks. The pre and post score values of berg balance scale and timed up and go test were measured and the values were analysed. RESULT: The post-test mean values and standard error mean of balance for both groups were 39.66 ± 0.541 and 47.666 ± 0.864. The F value was 2.888 and the P value was 0.000 showed there were significant differences between the groups. The statistical report of timed up and go test showed significant improvement in the gait speed after the application of the BWSTT along with FES but only turning and turn sitting variables of the TUGT showed insignificant result. CONCLUSION: The study concluded that the 6 weeks of gait training program with body weight supported treadmill training along with the functional electrical stimulation showed statistically significant improvement in functional mobility and balance when compared to the body weight supported treadmill training alone. In addition the use of functional electrical stimulation during the body weight supported treadmill training was preferred by the subjects and facilitated the work of the physiotherapist

    Effect of Lower Extremity Sensory Amplitude Electrical Stimulation on Motor Recovery and Function after Stroke: a Pilot Study

    Get PDF
    BACKGROUND AND PURPOSE: Post-stroke sensory dysfunction has been observedin more than 50-60% of all patients and negatively impacts motor control. Afferent input through sensory amplitude electrical stimulation (SES) has been associated with increased cortical excitability and plasticity, having a positive impact on the generation of skilled movement and function. The purpose of this study was to investigate the effect of lower extremity SES on motor and sensory recovery and function after first stroke for adult patients undergoing acute rehabilitation. METHODS: This study is part of an ongoing double blind, randomized controlled trial. Inclusion criteria: admitted to inpatient rehabilitation with first stroke, medically stable, sensory and/or motor dysfunction, and scored ≥26 on the Montreal Cognitive Assessment Score. Exclusion criteria: pre-morbid neurologic or balance disorders and a projected length of stay less than 6 days.The experimental group received SES and control group received sham stimulation over the peroneal nerve for 60 minutes daily prior to physical therapy. Both interventions were provided six days/week throughout the rehabilitation stay; subjects received an average of 12 treatments. Outcome measures included the Fugl-Meyer lower extremity sensory assessment, Lower Extremity Motricity Index (LEMI), Berg Balance Scale (BBS), gait speed, and the Functional Independence Measure (FIM). RESULTS: Forty-four patients were screened over six months: three patients met inclusion/exclusion criteria and consented to participate. Two females, one in the control group and one in the experimental group; and one male in the control group were recruited with an average age of 62.7, all with subcortical stroke. Subject one was seven days post-stroke, subjects two and three were five days post-stroke. Subjects in both groups showed meaningful improvement on LEMI and BBS. Only those in the contro group showed meaningful improvement on the FIM. Fugl-Meyer was normal for all subjects at baseline. Gait speed could not be assessed due to subjects’ inability to complete the test upon initial evaluation. The experimental subject showed the greatest amount of change in the LEMI compared to the control group. CONCLUSION: Due to a small sample size the results cannot be generalized to all who have experienced stroke. Additional research and subjects are necessary to gain a better understanding of how peripheral sensory stimulation can affect sensory recovery and functional gain following acute stroke

    A personalized multi-channel FES controller based on muscle synergies to support gait rehabilitation after stroke

    Get PDF
    It has been largely suggested in neuroscience literature that to generate a vast variety of movements, the Central Nervous System (CNS) recruits a reduced set of coordinated patterns of muscle activities, defined as muscle synergies. Recent neurophysiological studies have recommended the analysis of muscle synergies to finely assess the patient's impairment, to design personalized interventions based on the specific nature of the impairment, and to evaluate the treatment outcomes. In this scope, the aim of this study was to design a personalized multi-channel functional electrical stimulation (FES) controller for gait training, integrating three novel aspects: (1) the FES strategy was based on healthy muscle synergies in order to mimic the neural solutions adopted by the CNS to generate locomotion; (2) the FES strategy was personalized according to an initial locomotion assessment of the patient and was designed to specifically activate the impaired biomechanical functions; (3) the FES strategy was mapped accurately on the altered gait kinematics providing a maximal synchronization between patient's volitional gait and stimulation patterns. The novel intervention was tested on two chronic stroke patients. They underwent a 4-week intervention consisting of 30-min sessions of FES-supported treadmill walking three times per week. The two patients were characterized by a mild gait disability (walking speed > 0.8 m/s) at baseline. However, before treatment both patients presented only three independent muscle synergies during locomotion, resembling two different gait abnormalities. After treatment, the number of extracted synergies became four and they increased their resemblance with the physiological muscle synergies, which indicated a general improvement in muscle coordination. The originally merged synergies seemed to regain their distinct role in locomotion control. The treatment benefits were more evident for one patient, who achieved a clinically important change in dynamic balance (Mini-Best Test increased from 17 to 22) coupled with a very positive perceived treatment effect (GRC = 4). The treatment had started the neuro-motor relearning process also on the second subject, but twelve sessions were not enough to achieve clinically relevant improvements. This attempt to apply the novel theories of neuroscience research in stroke rehabilitation has provided promising results, and deserves to be further investigated in a larger clinical study

    Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research

    Get PDF
    Objective: To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions. Data sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov. Study selection: One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles. Data extraction: One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool. Data synthesis: Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4–6 weeks’ use (p = 0.49) showed equal improvement for both devices. Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses

    An Experimental study on Effectiveness of Conventional Physiotherapy Versus Functional Electrical Stimulation to Improve Upper Extremity Gross Manual Dexterity among subjects with Sub-Acute Ischemic Middle Cerebral Artery Stroke

    Get PDF
    INTRODUCTION: The term Stroke is “rapidly developing clinical sign of focal (or global) distribution of cerebral function, lasting for more than 24 hours or leading to death, with no apparent cause other than that of vascular origin. Functional electrical stimulation uses the electrical impulses to produce the muscular contraction in order to induce functional outcomes of non-innervated muscles in patient with neurological disorder. METHODOLOGY: 20 patients with sub-acute ischemic middle cerebral artery stroke were selected for this study based on the selection criteria and they were randomly allocated in to two groups by using closed envelop method. Subjects in group A were treated with convention physiotherapy and subjects in group B were treated with conventional physiotherapy along with the functional electrical stimulation. Both the group received intervention for 6 weeks. The baseline and post test score were measured by using fugl-meyer assessment scale and jebsen and taylor hand function test. RESULTS: The post-test mean values and standard error mean of fugl-meyer assessment scale (upper extremity) for both groups were 34.70 ± 0.366 and 44.700 ± 0.300. The F value was 0.691 and the P value was 0.000 showed there were significant differences between the groups. The post score values of the jebsen and taylor hand function test score in all the variables showed significant difference in between groups. CONCLUSION: Finally the study concluded that the 6 weeks of upper extremity training program with conventional physiotherapy along with the functional electrical stimulation showed statistically significant improvement in upper extremity gross manual dexterity when compared to the conventional physiotherapy training alone

    Physiotherapy and neuro rehabilitation on stroke evidence and needs

    Get PDF
    Scientific knowledge in the area of rehabilitation and physiotherapy for stroke is booming and leading to more sustainable models of practice. Several interventions show positive effects with strong scientific support. However, some issues remain to be clarified like what are the effects of PT on brain activity and what are the effects of hands on interventions. Also a general coherence of interventions and outcomes and outcomes measures need to improve. With the intent to clarify these questions and to give an overview of Physiotherapy evidence and needs on stroke rehabilitation, this thesis will present the state of the art on a literature review and the four studies developed on the context of this PhD: Physiotherapy Hands-on Interventions and Stroke - Systematic Review; Physiotherapy and Brain Activity on Stroke - Systematic Review; Brain activity during lower limb movement with physiotherapy manual facilitation – an fMRI study; ICF Linking Process for Categorization of Interventions and Outcomes Measures on Stroke Physiotherapy - Delphi panel. As innovative aspects of this thesis, we highlight: the organization within the ICF framework for the outcomes related with movement; the study of brain activity during a complex multijoint movement of lower limb; the study of immediate effects of manual facilitation of movement, as no similar studies was found on our literature search for this thesis. Regardless the limitations encountered, the non-conclusive findings and some non-identified evidence, it seems still valid to conclude that Physiotherapy is no longer a “black box”, instead is a evidence-based profession. Exists clear and evidence based information for clinical settings and scientific community, that hands off physiotherapy is relevant and has efficacy proved on the rehabilitation of stroke patients on the domains of Structure & Functions and Activities & Participation. This efficacy is extended to the brain activity, which validates the idea that PT can influence neuroplasticity process and consequently contribute for a better recovery in a neurobiological perspective with impact on human performance and autonomy.O conhecimento científico na area da intervenção em utentes com sequelas após Acidente Vascular Cerebral (AVC) e especificamente na área da Fisioterapia, tem crescido nos últimos ano, conduzindo a modelos de prática mais sustentados. São várias as intervneções da Fisioterapia com eficácia comprovada. Contudo, alguns aspectos ainda necessitam de clarificação, como seja quais os efeitos da Fisioterapia na actividade cerebral e quais são os efeitos das intervenções baseadas na manualidade do Fisioterapeuta. É ainda necessária, uma maior coerência entre as intervenções, as variáveis em estudo e os instrumentos de avaliação utilizados. Com o objectivo de contribuir para o esclarecimento destas questões e de oferecer uma visao global da evidência da intervenção da Fisioterapia e as necessidades de desenvolvimento na intervenção e utentes com AVC, esta tese apresenta um estado da arte na revisão de literature e os quarto estudos desenvolvidos no contexto deste doutoramento: Efeitos da Fisioterapia manual em utentes com AVC - revisão sistemática; Efeitos da Fisioterapia na actividade cerebral em utentes com AVC - revisão sistemática; Efeitos imediatos da facilitação manual na actividade cerebral - estudo com RMf; Processo de categorização de intervenções e intrumentos específicos da intervenção em utentes com AVC - Painel de Delphi. Como aspectos inovadores, salientamos a organização de acordo com a estrutura da CIF, para as variaveis relacionadas com o movimento; o estudo a actividade cerebral durante um movimento complexo e multi-articular do membro inferior; o estudo dos efeitos imediatos da facilitação manual na actividade cerebral. Independentemente das limitações encontradas, dos achados não conclusivos e alguns achados de não benefício de intervenções, parece-nos ser válido concluir que a Fisioterapia deixou de ser uma “caixa negra” sendo uma profissão científicamente suportada. Existe informação clara e suportada cientificamente, disponível para os locais de prática e para a comunidade científica, de que a Fisioterapia “hands off” é relevante e tem eficácia comprovada no contexto da intervenção em utentes com AVC, nos domínios da Estrutura e Função e da Actividade e Participação. Esta eficácia estende-se à actividade cerebral, validando a ideia de que a Fisioterapia pode influenciar a neuroplasticidade e consequentemente contribuir para uma recuperação neurobiológica mais adequada, com impacto no desempenho humano e autonomia
    • …
    corecore