Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke : a pilot randomized controlled trial

Background: Technology development for sitting balance therapy and trunk rehabilitation is scarce. Hence, intensive one-to-one therapist-patient training is still required. We have developed a novel rehabilitation prototype, specifically aimed at providing sitting balance therapy. We investigated whether technology-supported sitting balance training was feasible and safe in chronic stroke patients and we determined whether clinical outcomes improved after a four-week programme, compared with usual care. Methods: In this parallel-group, assessor-blinded, randomized controlled pilot trial, we divided first-event chronic stroke participants into two groups. The experimental group received usual care plus additional therapy supported by rehabilitation technology, consisting of 12 sessions of 50 min of therapy over four weeks. The control group received usual care only. We assessed all participants twice pre-intervention and once post-intervention. Feasibility and safety were descriptively analysed. Between-group analysis evaluated the pre-to-post differences in changes in motor and functional outcomes. Results: In total, 30 participants were recruited and 29 completed the trial (experimental group: n = 14; control group: n = 15). There were no between-group differences at baseline. Therapy was evaluated as feasible by participants and therapist. There were no serious adverse events during sitting balance therapy. Changes in clinical outcomes from pre- to post-intervention demonstrated increases in the experimental than in the control group for: sitting balance and trunk function, evaluated by the Trunk Impairment Scale (mean points score (SD) 7.07 (1.69) versus 0.33 (2.35); p < 0.000); maximum gait speed, assessed with the 10 Metre Walk Test (mean gait speed 0.16 (0.16) m/s versus 0.06 (0.06) m/s; p = 0.003); and functional balance, measured using the Berg balance scale (median points score (IQR) 4.5 (5) versus 0 (4); p = 0.014). Conclusions: Technology-supported sitting balance training in persons with chronic stroke is feasible and safe. A four-week, 12-session programme on top of usual care suggests beneficial effects for trunk function, maximum gait speed and functional balance

Effect of trunk training on body function and activity post stroke: a systematic review and meta-analysis

status: Published onlin

Effectiveness of somatosensory interventions on somatosensory, motor and functional outcomes in the upper limb post-stroke: A systematic review and meta-analysis

BACKGROUND: Research mainly focuses on motor recovery of the upper limb after stroke. Less attention has been paid to somatosensory recovery. OBJECTIVE: To review and summarize the effect of upper limb somatosensory interventions on somatosensory impairment, motor impairment, functional activity and participation after stroke. METHODS: Biomedical databases Ovid Medline, EMBASE, Web of Science, PEDro, and OTseeker were searched with an update in May 2018. Randomized controlled trials investigating the effect of somatosensory-specific interventions focusing on exteroceptive, proprioceptive or higher cortical somatosensory dysfunction, or any combination were eligible for inclusion. Quality of included studies were assessed using Physiotherapy Evidence Database (PEDro) scale. Standardized Mean Differences and Mean Differences and 95% confidence intervals were calculated and combined in meta-analyses. RESULTS: Active somatosensory interventions did not show a significant effect on somatosensation and activity, but demonstrated a significant improvement in motor impairment (SMD = 0.73, 95% CI = 0.14 to 1.32). No study evaluating active somatosensory intervention included participation. Passive somatosensory interventions significantly improved light touch sensation (SMD = 1.13, 95% CI = 0.20 to 2.05). Passive somatosensory interventions did not show significant effects on proprioception and higher cortical somatosensation, motor impairment, activity and participation. CONCLUSIONS: To date, there is low quality evidence suggesting active somatosensory interventions having a beneficial effect on upper limb impairment and very low quality evidence suggesting passive somatosensory interventions improving upper limb light touch sensation. There is a need for further well-designed trials of somatosensory rehabilitation post stroke.status: publishe

Do trunk exercises improve trunk and upper extremity performance, post stroke? A systematic review and meta-analysis

BACKGROUND: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear.Objective: To evaluate the effect of trunk exercises on trunk performance post-stroke, and to determine if these exercises result in improved upper limb function.METHODS: A comprehensive search of the literature published between January 1990 and February 2017 was conducted using the following electronic databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDiscus. Only randomized, controlled trials, published in English, evaluating the effect of trunk exercises on trunk performance and/or upper limb function post-stroke, were included.RESULTS: A total of 17 studies involving 599 participants were analysed. Meta-analysis showed that trunk exercises had large significant effect on trunk performance post-stroke. This effect varied from very large for acute stroke to medium for subacute and chronic stroke. None of the included studies had measured the effect of trunk exercise on upper limb impairment or functional activity.CONCLUSIONS: Trunk exercises improve trunk performance for people with acute, subacute and chronic stroke. As yet there is no evidence to support the effect of trunk exercise on upper limb function.<br/

Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content

Background: Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and contentof a VR training intervention to a conventional task-oriented intervention (CT). Methods: A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standard ized scoring form was used to analyze intensity, i.e.active use of the affected UL expressed in % of total time, total active time and total duration of a training sessionin minutes, content of training and feedback. Two raters collected data independently. Linear regression models aswell as descriptive and graphical methods were used. Results: Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While in VR severely impaired patients spent 80.7 % (4.4 %) of the session time actively; they reached 60.6 (12.1) % in CT. VR and CT also differed in terms of tasks and feedback provided. Conclusion: Our results indicate that patients with severely impaired UL motor function spent more time actively in VR training, which may influence recovery. The upcoming results of the VIRTUES trial will show whether this is correlated with an increased effect of VR compared to CT.status: publishe

Effectiveness of different types and duration of trunk training on trunk function: a systematic review and meta-analysis

status: publishe

Brain connectivity alterations after additional sensorimotor or motor therapy for the upper limb in the early-phase post stroke : a randomized controlled trial

Sornatosensory function plays an important role for upper limb motor learning. However, knowledge about underlying mechanisms of sensorimotor therapy is lacking. We aim to investigate differences in therapy-induced resting-state functional connectivity changes between additional sensorimotor compared with motor therapy in the early-phase post stroke. Thirty first-stroke patients with a sensorimotor impairment were induded for an assessor-blinded multi-centre randomized controlled trial within 8 weeks post stroke [13 (43%) females; mean age: 67 +/- 13 years; mean time post stroke: 43 +/- 13 days]. Patients were randomly assigned to additional sensorimotor (n = 18) or motor (n = 12) therapy, receiving 16 h of additional therapy within 4 weeks. Sensorimotor evaluations and resting-state functional magnetic resonance imaging were performed at baseline (T1), post-intervention (T2) and after 4 weeks follow-up (T3). Resting-state functional magnetic resonance imaging was also performed in an age-matched healthy control group (n = 19) to identify patterns of aberrant connectivity in stroke patients between hemispheres, or within ipsilesional and contralesional hemispheres. Mixed model analysis investigated session and treatment effects between stroke therapy groups. Non-parametric partial correlations were used to investigate brain-behaviour associations with age and frame-wise displacement as nuisance regressors. Connections within the contralesional hemisphere that showed hypo-connectivity in subacute stroke patients (compared with healthy controls) showed a trend towards a more pronounced pre-to-post normalization (less hypo-connectivity) in the motor therapy group, compared with the sensorimotor therapy group (mean estimated difference = -0.155 +/- 0.061; P = 0.02). Further, the motor therapy group also tended to show a further pre-to-post increase in functional connectivity strength among connections that already showed hyper-connectivity in the stroke patients at baseline versus healthy controls (mean estimated difference = -0.144 +/- 0.072; P= 0.06). Notably, these observed increases in hyper-connectivity of the contralesional hemisphere were positively associated with improvements in functional activity (r= 0.48), providing indications that these patterns of hyper-connectivity are compensatory in nature. The sensorimotor and motor therapy group showed no significant differences in terms of pre-to-post changes in inter-hemispheric connectivity or ipsilesional intrahemispheric connectivity. While effects are only tentative within this preliminary sample, results suggest a possible stronger normalization of hypo-connectivity and a stronger pre-to-post increase in compensatory hyper-connectivity of the contralesional hemisphere after motor therapy compared with sensorimotor therapy. Future studies with larger patient samples are however recommended to confirm these trend-based preliminary findings

Effectiveness of different types and duration of trunk training on trunk function: a systematic review and meta-analysis

status: Published onlin

Somatosensory impairments in the upper limb post stroke: distribution, impact of visuo-spatial neglect and association with motor function

status: accepte