Precision grip in chronic stroke patients : evaluation and rehabilitation

This thesis aims to advance the evaluation and rehabilitation of precision grip in chronic stroke patients. Stroke is a leading cause of permanent deficits worldwide, and fine manipulation skills are often disturbed in the paretic hand. The evaluation of predictive and reactive control in this population highlighted deficits in the paretic hand under both conditions. Patients also displayed a significant decrease in digital dexterity and an increase in the time taken to lift the manipulandum with the paretic hand compared with the non-paretic hand and control subjects. A specific rhythmic bilateral grip-lift task oriented therapy undertaken three times per week for 8 weeks did not modify grip-lift task parameters, digital dexterity, manual ability or subjects’ satisfaction with their participation in activities of daily living. Patients’ perceptions of increased ease and fluency of manipulation after therapy was not measured through these evaluations. The suggestion of changes in cortical activity related to the task led us to develop a fMRI compatible manipulandum and concomitant EMG recording setup. With a specific evaluation protocol, this proved to be accurate at least in healthy adults. Nevertheless, there are limitations to the fMRI method. Two of them are the subjects’ supine position and the restriction of their view of the manipulated object during image acquisition. These parameters have been shown to influence grip-lift task performance in healthy adults. There is a strong recommendation to consider position and view during rehabilitation and to assess the patient under the same conditions during fMRI. The literature also recommends adding at least one further brain mapping technique to complete the evaluation. In conclusion, chronic stroke subjects have manipulation disabilities that should be considered for rehabilitation. There is a strong need to combine structure and function specific evaluation in determining which type of therapy is appropriate for each patient in terms of functional recovery level, cortical lesion site and cortical excitability.(MOTR - Sciences de la motricité) -- UCL, 201

Les bienfaits de l'activité physique chez les enfants en situation de handicap

Nous abordons les bienfaits de l'activité physique chez les enfants et plus particulièrement chez les enfants en situation de handicap, avec développement des aspects physiologiques, psychosociaux et familiaux; de même que quelques éléments sur les facteurs motivants et limitants de la pratique d'activités physiques et sportives

The effect of repetitive rhythmic precision grip task-oriented rehabilitation in chronic stroke patients : a pilot study.

Most chronic stroke patients present with difficulty in the manipulation of objects. The aim of this study was to test whether an intensive program of precision grip training could improve hand functioning of patients at more than 6 months after a stroke. This was a cross-over study; hence, at inclusion, the patients were randomly divided into two groups: one group started with the bilateral movement therapy and the other group started with the unilateral movement therapy. The patients were assessed on four separate occasions across a 12-week period: (a) at inclusion in the study, (b) 4 weeks later, immediately before the first rehabilitation session, (c) after 4 weeks of one therapy, and (d) after a further 4 weeks of the other therapy. Ten patients completed two consecutive 4-week sessions (1 h, 3 days/week) of therapy. The therapy comprised unilateral and bilateral repetitive grip-lift task-oriented rehabilitation with rhythmic auditory cueing. The grip-lift force coordination, digital dexterity, manual ability, and the level of satisfaction (with activities and participation) were assessed. A one-way repeated-measure analysis of variance across the four evaluations did not detect any objective improvement in the measured variables after 8 weeks of specific intensive training. Precision grip training was shown to not generate significant improvement in the grip-lift task, digital dexterity, manual ability, or satisfaction in chronic stroke patients

Influence of vision and posture on grip-lift task parameters in healthy adults.

The grip-lift task enables a quantitative assessment of grasping ability. Patients are regularly assessed in a supine position, which offers a different view of the grasped object from that in the sitting position. To our knowledge, no data are currently available on the influence of posture and vision on grip-lift task parameters. We therefore aimed to determine the effects of posture and vision on these parameters. Twenty-six healthy right-handed adults performed grip-lift tasks with a manipulandum that measured different temporal and dynamic parameters in four conditions: sitting eyes open, sitting blindfolded, lying down eyes open and lying down blindfolded. A repeated-measures analysis of variance with two factors (vision and position) showed that the absence of vision affected all the parameters measured. The lying down position increased the time between the first contact with the object and the modification of the vertical force as well as the delay between the first increase of the horizontal force and the increase of the vertical force. In addition, there was a lower adaption of the horizontal force, required to squeeze the object, to the vertical force. Finally, the interaction of position and vision was associated with significant differences in the delay between the contact of each digit with the object, the maximum horizontal force and the ratio between the horizontal and vertical force during a static holding period. Both position and vision appear to affect the grip-lift task. Consequently, sequential assessments should be performed in the same condition to obtain reliable data

A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders.

OBJECTIVE: To investigate the agreement between the self-reported and examiner-reported difficulties of patients with neuromuscular disorders (NMDs) in performing daily activities at home. DESIGN: A comparison between 2 methods of administering a measurement instrument. SETTING: Neuromuscular reference center in a university hospital. PARTICIPANTS: Adult patients (N=57) with diagnosed NMDs living at home. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The ACTIVLIM questionnaire. RESULTS: The intraclass correlation coefficient, model 2,1 (ICC(2,1)), between the measures was very good (ICC(2,1)=.87), indicating a good agreement between self-perceived and observed measures. CONCLUSIONS: The use of ACTIVLIM as a self-reporting questionnaire is a valid method for assessing activity limitations in patients with NMD

Can items on the TIMP aide in determining the motor performance of children with severe cerebral palsy? A pilot study.

Assessing the functional level of children with severe cerebral palsy (CP) requires sensitive tools. In this study, an 'assessment tool' was developed based on the Test of Infant Motor Performance (TIMP) for this population and the reliability and validity evaluated. Five physical therapists administered the 'assessment tool' to six children (3-6 years old with a diagnosis of CP, GMFCS Level V). Subtest I of the Gross Motor Function Measure (GMFM-88) was also administered. Intra- and inter-rater reliability were assessed, and the concurrent validity between the 'assessment tool' and GMFM-88 calculated. The intra-rater reliability, a comparison of the total scores on the 'assessment tool' (live test) and the videotaped rescoring of the same test one month later showed consistency among four of the five therapists (ICC =0.7545 to 0.979). The inter-rater reliability varied on some of the items but the total score on the 'assessment tool' showed good reliability (ICC 0.816). Scores of children with dyskinesia were less stable. The Spearman's rank correlation coefficient was not significant. Therapists provided recommendations for item revisions. Further development of an 'assessment tool' appears justified; a larger study using a version with revised administration guidelines and items should be undertaken to re-verify the psychometrics properties of the 'assessment tool.

Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Upper Limb Robot-Assisted Therapy in Cerebral Palsy: A Single-Blind Randomized Controlled Trial

Background. Several pilot studies have evoked interest in robot-assisted therapy (RAT) in children with cerebral palsy (CP). Objective. To assess the effectiveness of RAT in children with CP through a single-blind randomized controlled trial. Patients and Methods. Sixteen children with CP were randomized into 2 groups. Eight children performed 5 conventional therapy sessions per week over 8 weeks (control group). Eight children completed 3 conventional therapy sessions and 2 robot-assisted sessions per week over 8 weeks (robotic group). For both groups, each therapy session lasted 45 minutes. Throughout each RAT session, the patient attempted to reach several targets consecutively with the REAPlan. The REAPlan is a distal effector robot that allows for displacements of the upper limb in the horizontal plane. A blinded assessment was performed before and after the intervention with respect to the International Classification of Functioning framework: body structure and function (upper limb kinematics, Box and Block test, Quality of Upper Extremity Skills Test, strength, and spasticity), activities (Abilhand-Kids, Pediatric Evaluation of Disability Inventory), and participation (Life Habits). Results. During each RAT session, patients performed 744 movements on average with the REAPlan. Among the variables assessed, the smoothness of movement (P < .01) and manual dexterity assessed by the Box and Block test (P =.04) improved significantly more in the robotic group than in the control group. Conclusions. This single-blind randomized controlled trial provides the first evidence that RAT is effective in children with CP. Future studies should investigate the long-term effects of this therapy

Interrater Reliability of Activity Questionnaires After an Intensive Motor-Skill Learning Intervention for Children With Cerebral Palsy.

OBJECTIVE: To investigate the reliability of parents-reported activity questionnaires after a motor-skill learning intervention for children with cerebral palsy (CP). We hypothesize that the intervention process might influence parental judgment. DESIGN: Double-blind randomized trial. SETTING: Conventional therapy was delivered in the usual context while intensive intervention was provided at the Catholic University of Louvain. PARTICIPANTS: Children with CP (N=41; age range 5-18y, Gross Motor Function Classification System I-IV) were randomized to a control group (CG) (n=21, 2 dropouts) receiving conventional therapy or an intervention group (IG) (n=20) receiving hand-arm bimanual intensive therapy-including lower extremities (HABIT-ILE). INTERVENTIONS: Conventional therapy (mostly neurodevelopmental) was delivered as ongoing treatment (1-5 times/wk). HABIT-ILE, based on motor-skill learning, was delivered over 2 weeks. All children were assessed at T1 (baseline), T2 (3wk after baseline) and T3 (4mo after baseline). MAIN OUTCOMES MEASURES: ABILHAND-Kids and ACTIVLIM-CP questionnaires rated by parents (perception) and 2 examiners (videotapes). RESULTS: Agreement (level/range) between examiners was systematically almost perfect (P≤.001). At baseline, moderate to almost perfect agreement (level/range) was observed between parents and examiners (P≤.001). At T2 and T3, a similar agreement (level/range) was observed for the CG. For the IG, a similar level of agreement was observed, but the range of agreement varied from poor to almost perfect (P≤.001), with parents estimating higher performance measures compared to examiners after intervention. Higher performance was associated with higher satisfaction scores of the child's functional goals at T3. CONCLUSION: Parents and examiners have a similar perception of the child's performance at baseline and during conventional therapy. Their perceptions are less congruent after a motor-skill learning intervention, probably due to the goal-oriented process of the intervention. Therefore, our results favor the use of blind observations of home-videotaped items after intensive motor-skill learning interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02667613