• PNF and Movement
• /
• v.16 no.3
• /
• pp.451-460
• /
• 2018

Purpose: The purpose of this study was to investigate the effects of a modified constraint induced movement therapy (mCIMT) using proprioceptive neuromuscular facilitation (PNF) on the upper extremity function and activities of daily living (ADLs) in patients with subacute stroke. Methods: Fourteen participants with subacute stroke were randomly assigned to a group using both mCIMT and PNF or a group using mCIMT alone. Each group underwent twenty sessions (1 h/d, 5 d/wk) for 4 weeks. Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer assessment for the upper extremities (FMA-UE), the Modified Barthel Index (MBI), and motor activity logs (MALs; amount of use [AOU] and quality of movement [QOM]). Results: Both the experimental group and the control group showed significant intragroup improvement in the ARAT, FMA-UE, MBI, and MAL-AOU (p<0.05). The group using both mCIMT and PNF exhibited greater improvement in the ARAT, FMA-UE, MBI, and MAL-AOU than did the group using mCIMT alone. Statistical analyses showed significant differences in the ARAT (p=0.01), FMA-UE (p=0.01), MBI (p=0.00), and MAL-AOU (p=0.01) between the groups. Conclusion: This study applied mCIMT combined with PNF for subacute stroke patients, and the results showed significant improvements in the patients' upper extremity function and ADLs. Therefore, mCIMT using PNF may be more effective than mCIMT alone in improving upper limb function and ADLs in patients with subacute stroke.

• Physical Therapy Rehabilitation Science
• /
• v.11 no.1
• /
• pp.8-15
• /
• 2022

Objective: Post stroke motor recovery is facilitated by the brain reorganization or the neuroplastic changes. The therapeutic approach mentioned in the current case is one of the approaches for enhancing motor recovery by stimulating the damaged neural networks directing the motor behaviour of a person. The aim of the present study was to establish the changes in the balance and gait pattern of an individual through multi target stimulation of areas of cerebral cortex by utilising multichannel trans cranial direct current stimulation (M-tDCS) in a sub-acute stroke survivor. Design: A Case Report Methods: The present patient was the participant of the trial (CTRI/2021/02/031044).The patient was intervened with M-tDCS (anodes over left primary motor cortex that is C3 point and left dorsolateral prefrontal cortex i.e., F3 point and cathodes over supraorbital areas, Intensity - 1.2mA) for the duration of 20 minutes along with turbo med extern - an AFO to facilitate ankle dorsi flexion and conventional physiotherapy rehabilitation. The Fugl-Meyer assessment lower extremity (FMA-LE), Berg Balance Scale (BBS), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures were used for outcome assessment. Baseline assessment was done on day 0 followed by assessment on 10 and 20 post intervention. Results: Improvement was seen in all the tools i.e. (FMA -LE), BBS, SSQOL and WGS over the time period of 20 days. Conclusions: M-tDCS resulted in improvement in gait parameters, balance and motor functions of lower extremity of the patient.

• Physical Therapy Rehabilitation Science
• /
• v.9 no.4
• /
• pp.318-323
• /
• 2020

Objective: Reacquisition of motor functions following stroke depends on interhemispheric neural connections. The intervention highlighted in the present case is an insight for augmenting motor recovery by stimulating the lesioned area and adjacent areas governing the motor behaviour of an individual. The purpose of this study was to determine the changes in the motor and cognitive outcomes through multi target stimulation of cortical areas by application of multichannel transcranial direct current stimulation (M-tDCS) in a stroke survivor. Design: A case report. Methods: The patient was a participant of a trial registered with the clinical trial registry of India (CTRI/2020/01/022998). The patient was intervened with M-tDCS over the left primary motor cortex i.e. C3 point and left dorsolateral prefrontal cortex i.e. F3 point with 0.5-2 mA intensity for the period of 20 minutes. SaeboFlex-assisted task-oriented training, functional electrical stimulation over the lower extremity (LE) to elicit dorsiflexion at the ankle and eversion of the foot, and conventional physiotherapy rehabilitation including a tailored exercise program were performed. Outcome assessment was done using the Fugl-Meyer assessment scale (FMA) for the upper and lower extremity (UE and LE), Montreal Cognitive Assessment (MOCA), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures. Assessment was taken at Day 0, 15 and 30 post intervention. Results: Improvement was observed in all the outcome measures i.e FMA (UE and LE), MOCA, SSQOL and WGS across the span of 4 weeks. Conclusions: M-tDCS induced improvement in motor functions of the UE and LE, gait parameters and cognitive functions of the patient.

• The Journal of Korean society of community based occupational therapy
• /
• v.4 no.1
• /
• pp.33-45
• /
• 2014

Objective : We tested the effect of mirror treatment on patients with and without unilateral neglect over a period of 4 weeks. We also wanted to know the effect of mirror treatment with regards to improving upper extremity function and dealing with activities of daily living. Methods : Subjects were 10 hemiplegia patients with unilateral neglect and 10 hemiplegia patients without unilateral neglect. They visited the department of occupational therapy. We performed mirror treatment for 30 minutes, 5 times a week for 4 weeks. We used Albert Test to compare our results from before and after the treatment, Fugl-Meyer motor function Assessment(FMA) and Box & Block Test(BBT) for upper extremity function, and Functional Independence Measure(FIM) for activities of daily living. Results : The results showed that mirror treatment had an effect on stroke patients with unilateral neglect. The treatment also had an effect on upper extremity function and activities of daily living regardless of unilateral neglect. Conclusion : The mirror treatment showed improvements on upper extremity function and activities of daily life as well as a reduction in the unilateral neglect after a stroke. In conclusion, the mirror treatment is useful for recovering function and improvement and for helping the patients complete activities of daily living.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.16 no.8
• /
• pp.5132-5142
• /
• 2015

The purpose of this study was to find effect of upper extremities exercises using two different supporting surface, mobile surface and fixed surface in sitting on the function of upper extremities for the patients with stroke. The study period was between July 5, 2012 and August 1 2012. The subjects were 20 subjects who were randomly divided into two groups : (1) mobile surface group, (2) fixed surface group. The mobile surface group performed bilateral upper extremities exercise sitting on balance disc, and the fixed surface group was provided fixed surface chair. Both groups performed 30 minutes 5 times per a week for 4weeks. The Manual Functional Test(MFT) and Fugl-Meyer Motor Function Assessment(FMA) was used to measure the differences of upper extremity functions before and after interventions. The results of this study were as follows. First, Both groups, mobile surface group and fixed surface group showed the significant increase(p<.05) in upper extremity function. Second, the improvements of the hand function in mobile surface group showed significant difference comparing with the group with fixed surface. Therefore, the results of this study showed the bilateral hand exercise program on mobile surface is more effective than the fixed surface bilateral hand exercise program for the patients with stroke.

• Journal of The Korean Society of Integrative Medicine
• /
• v.8 no.2
• /
• pp.11-20
• /
• 2020

Purpose : The purpose of this study was to research the effects of dual-hemisphere transcranial direct current stimulation (dual tDCS) and modified constraint-induced movement therapy (mCIMT) to improve upper extremity motor function after stroke. Methods : The study period was from August 2019 to November 2019, and included 24 patients who met the selection criteria. Participants were divided into 2 groups: dual tDCS and mCIMT, and sham dual tDCS and mCIMT group. Dual tDCS and mCIMT group performed mCIMT immediately after applying dual tDCS for 20 minutes, and sham dual tDCS and mCIMT group performed mCIMT immediately after applying sham tDCS for 20 minutes without turning on the power source. Total interventions were conducted 5 times per week for 4 weeks, and mCIMT was conducted for 30 minutes per session for both experimental and control groups. Fugl-Meyer assessment (FMA) and Motor Activity Log scale (MAL) were analyzed before and after 4 weeks of intervention. Results : Both experimental and control groups showed significant changes in FMA, Amount of Use (AOU), and Quality of Movement (QOM) of MAL. When the differences between groups was compared using ANCOVA, the experimental group showed a greater improvement in FMA and AOU of MAL than the control group. Conclusion : In order to enhance the effect of improving upper limb function of stroke patients, dual tDCS could be applied to provide more effective treatment in the clinical setting. Further studies will be needed in larger groups of stroke patients, including long-term follow-up, and multi-group comparisons through the establishment of anodal tDCS and mCIMT, cathodal tDCS, and mCIMT groups to clarify the effects of dual tDCS. In addition, research is needed to establish a protocol for tDCS, and this evidence-based intervention protocol is expected to be used in the clinical setting as an interventional method for various purposes.

• Physical Therapy Rehabilitation Science
• /
• v.8 no.2
• /
• pp.93-98
• /
• 2019

Objective: The purpose of this study was to investigate the effect of robot arm reach training on upper extremity functional movement in chronic stroke survivors. Design: One group pretest-posttest design. Methods: Thirteen chronic stroke survivors participated in this study. Robot arm reach training was performed with a Whole Arm Manipulator (WAM) and a 120-inch projective display to provide visual and auditory feedback. During the robotic arm reach training, WAM provided gravity compensation and assist-as-needed (AAN) force according to the robot control mode. When a participant could not move the arm toward the target for more than 2 seconds, WAM provided AAN force to reach the desired targets. All patients participated in the training for 40 minutes per day, 3 times a week, for 4 weeks. Main outcome measures were the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT) and Box and Block Test (BBT) to assess upper extremity functional movement. Results: After 4 weeks, significant improvement was observed in upper extremity functional movement (FMA: 42.15 to 46.23, BBT: 12.23 to 14.00, p<0.05). In the subscore analysis of the FMA upper extremity motor function domains, significant improvement was observed in upper extremity and coordination/speed units (p<0.05). However, there were no significant differences in the ARAT. Conclusions: This study showed the positive effects of robot arm reach training on upper extremity functional movement in chronic stroke survivors. In particular, we confirmed that robot arm reach training could have a positive influence by leading to improvement of motor recovery of the proximal upper extremity.

• The Journal of Internal Korean Medicine
• /
• v.28 no.3
• /
• pp.492-501
• /
• 2007

Objectives : This study was executed in order to evaluate the effects of electroacupuncture on upper-extremity spasticity control in stroke patients. Methods : Eighteen patients with stroke were enrolled and classified into two groups, the study and control group. The control group did not receive any oriental medical treatment. In the study group, the electroacupuncture points were applied to Kokt'aek (PC3) and $Ch'{\u{o}}ch'{\u{o}}n$ (PC2), Naegwan (PC6) and $Ch'{\u{o}}kt'aek$(LU5) of the affected limb. H-reflexl M-response ratio (HIM ratio), modified Ashworth scale (MAS) and Fugl-Meyer motor function assessment (FMA) were used for evaluation of spasticity control before electroacupuncture, within two hours after electroacupuncture, and at two weeks. Results : In MAS, the study group declined more than the control group. but there was no statisticallysignificant consideration. In H/M ratio. the study group was more efficient than the control group. and spasticity decreased successively during the series in the study group. In FMA, motor function in the study group improved more than in the control group and motor function in the study group increased successively during the series. Conclusions : These results showed that electro acupuncture was a useful method to decrease upper-extremity spasticity in patients with stroke. Further studies are needed to explore more cases and the long-lasting carryover effects on upper-extremity spasticity in electroacupuncture.

• Journal of the Korean Society of Physical Medicine
• /
• v.11 no.3
• /
• pp.125-131
• /
• 2016

PURPOSE: The objective of this research is to investigate the effectiveness of mental practice on function and muscle activation of upper extremity (UE) in stroke patients. METHODS: The mental practice was conducted on 12 subjects for 10 minutes and the related existing work treatment for 20 minutes. The evaluation for the function of UE proceeded with Fugl-Meyer assessment of motor function (FMA) and muscle activity analysis instrument. Furthermore we analyzed patients' reaching activity by two stages, reaching phase and returning to original position phase. RESULTS: According to the research results, the subjects' upper limb function improved in all of the measured items and the total scores after the mental practice (p<.05). In muscle activity, CCR value was used to efficiently analyze the patients' reaching activity in the two stages of reaching stage and returning to the original position phase. While the elbow movement only had a bit of positive change (1.1%) in the reaching stage, both the shoulder (-12.3%) and elbow (-18.2%) movements had a positive change in the returning to original position phase. CONCLUSION: This research confirmed that the mental practice is effective for the enhancement of UE function for stroke patients. The result of this research can contribute to the progress of mental practice in clinical environment.

• The Journal of Internal Korean Medicine
• /
• v.37 no.4
• /
• pp.645-652
• /
• 2016

Objectives: To compare the effects of Eastern-Western integrative medical care (EWIM) and Western single rehabilitation therapy (WSRT) on the functional recovery of stroke patients.Methods: Seventy-six stroke patients were recruited retrospectively. The participants were divided into two groups: EWIM and WSRT. Data on age, sex, stroke-related risk factors, stroke type, neurological deficits according to the National Institutes of Health Stroke Scale (NIHSS), elapsed time to the initiation of rehabilitation, duration from the onset to follow up, initial functional status, and function after therapy for 3 mon were obtained from a review of the patients’ medical records. Between-group differences in functional outcomes were analyzed before and after treatment using the functional ambulation category (FAC), Fugl-Meyer assessment (FMA), modified Barthel Index-Korean version (K-MBI), and Euro-Quality of Life-5 Dimension (EQ-5D).Results: At 3-mon poststroke, all the functional outcome measures had improved in both groups (P<0.05). However, the improvements were greater in the EWIM group, and the improvement was statistically significant in the K-MBI (P=0.048) and EQ-5D (P=0.042).Conclusions: With respect to activities of daily living and health-related quality of life, EWIM is a more effective stroke therapy than WSRT.