Tactile spatial resolution in unilateral brain lesions and its correlation with digital dexterity

Objective: To test the tactile spatial resolution in chronic unilateral brain lesions. Additionally, since sensory deficits are thought to have an impact on motor deficits, this study investigated the correlation between tactile spatial resolution and finger dexterity. Design: Descriptive cross-sectional study. Patients: Twenty-two patients with unilateral brain lesions (12 children with congenital hemiplegia and 10 patients after stroke). Methods: Tactile spatial resolution was measured with a grating orientation task, and finger dexterity with the Purdue Pegboard Test. Results: Major tactile spatial resolution deficits were measured on the paretic hand and preserved abilities on the non-paretic hand, both in children with congenital hemiplegia and in patients after stroke. No correlation was found between the deficits of tactile spatial resolution and digital dexterity in the paretic hand (r=0.126; p=0372). Conclusion: The specific location of tactile spatial resolution deficits on the hand contralateral to the lesion was surprising when one considers the left hemispheric dominance of tactile spatial resolution in healthy subjects. The absence of correlation between tactile spatial resolution and dexterity deficits suggest that these abilities are not related, suggesting that they should be considered separately and equally integrated into the rehabilitation of unilateral brain lesions

Treatment of genu recurvatum in hemiparetic adult patients: A systematic literature review.

INTRODUCTION AND METHODS: We carried out a systematic review of the literature on treatment of genu recurvatum in hemiparetic adult patients by searching the PubMed, Pedro, Trip Database and Science Direct databases. The following keywords were used: (recurvatum or hyperextension or knee) and (hemiplegia or hemiparesis). RESULTS: Nine articles met our selection criteria. Four assessed retraining methods (functional electric stimulation or electrogoniometric feedback), two assessed orthopaedic or neurosurgical treatments and three articles focused on orthoses. DISCUSSION AND CONCLUSION: Even though all the various treatments produced encouraging results, most of the reviewed studies presented methodological limitations. Moreover, none of the selected articles suggested a treatment strategy which takes account of the various aetiologies in genu recurvatum. On the basis of some of the reviewed articles and our own clinical experience, we propose an aetiology-specific treatment strategy for genu recurvatum patients. In a broad patient population, this categorization could form the basis for testing the specificity of each treatment method as a function of the cause of genu recurvatum. This approach could help confirm the clinical indications and identify the most appropriate treatment for each patient

Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial

Abstract Background The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention. Methods Forty children with unilateral cerebral palsy (5–18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a “REAtouch®” experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3–T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the “REAtouch®” group versus the “HABIT-ILE” control group. Results We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05). Conclusions Use of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions. Trial registration: Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018