• Korean Journal of Adult Nursing
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• v.16 no.4
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• pp.626-635
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• 2004

Purpose: The purpose of this study was to explain the effects of upper extremity exercise program on hemiplegic stroke patients. Method: The research was designed by a non-equivalent pretest-posttest way. The data were collected from February to August 2003 at a community health center located in Seoul. The study subjects were a conveniently selected group of 27 hemiplegic patients. The subjects were divided into two groups, the experimental group and the control group. 14 subjects were assigned to the experimental group in which the subjects did the upper extremity exercise training for 2 hours once a week during four weeks, while 13 subjects were assigned to the control group. The outcomes were evaluated on the basis of the upper extremity motor ability(hand power, pinch power, upper extremity ROMs), amount of motor use and the degree of depression. Result: 1. After treatment, the motor abilities of the affected upper extremity(hand power, pinch power, ROMs of wrist flexion/extension, shoulder extension) were significantly different between the two groups. However, there were no significant differences in elbow and shoulder flexion between experimental and control group. 2. After treatment, amount of motor use of affected upper extremity were significantly different between the two groups. 3. After treatment, the degree of depression were significantly different between the two groups. Conclusion: In considering these results, the upper extremity exercise program could be effective for hemiplegic patients by improving the function of their upper extremity. Long-term studies are needed to determine the effects of upper extremity exercise program.

• Therapeutic Science for Rehabilitation
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• v.1 no.2
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• pp.35-40
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• 2012

The purpose of this review was to investigate feasibility of intensive virtual reality training to improve upper extremity function with brain plasticity of individuals with stroke through the literature. The recovery of the paretic upper extremity depends on regularity and intensity of training as use-dependent plasticity. In resent, virtual reality program has been widely used in the occupational therapy field of augmented stroke rehabilitation. There is a growing body of evidence that virtual reality training of the paretic extremity induces brain plasticity associated with motor improvement. In terms of therapeutic feasibility to improve paretic upper extremity, recent research has explored several important factors of virtual reality training for recovery of upper extremity motor function. These factors include high repetition intensity, high motivation like type of game, enhanced multisensory feedback regarding performance, and interactive task-oriented training. Therefore, occupational therapy combined with intensive and repetitive virtual reality training will enhance recovery of upper extremity motor function after stroke.

• PNF and Movement
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• v.16 no.3
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• pp.495-503
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• 2018

Purpose: This study analyzes the predictive power of upper extremity activity and the activities of daily living in patients with stroke using an easy-to-use evaluation tool. Methods: The Fugl-Meyer assessment (FMA) of the upper extremity and action research arm test (ARAT) are performed, and the Korean modified Barthel index (K-MBI) is measured. The predictive power of the upper extremity activity level and the daily activity level are analyzed using regression analysis. The statistical significance level is 0.05. Results: The coefficient of determination, R2, for predicting the ARAT using FMA was high at 0.88, but the regression equation for predicting the K-MBI using the FMA and ARAT did not show a statistically significant difference. Conclusion: The assessment of the upper extremity should be performed at the activity level, as well as the impairment level. The assessment for predicting the activities of daily living should be carried out for each level of the international classification of functioning (ICF), disability, and health, which can be linked to daily life, in addition to the assessment of the upper arm. Future research should conduct more diverse analyses using the ICF assessment tools at various levels.

• Physical Therapy Korea
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• v.18 no.2
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• pp.67-75
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• 2011

The purpose of this study was to investigate the effects of virtual reality (VR) therapy with compensation inhibition and feedback (CIF) on upper extremity function in chronic stroke patients. Seven chronic stroke patients participated in this study, which was a randomized controlled trial with a crossover design. Self upper extremity exercise, conservative VR therapy, and VR therapy with CIF were performed for one hour per session, 5 times per week, over a 3 week period. The main outcome measures involved range of motion (ROM) including shoulder, elbow, and wrist joints, a Manual Function Test (MFT), and a Motor Activity Log (MAL). Data were calculated as posttest and pretest changes in every session and were analyzed using Friedman and Wilcoxon signed-rank tests at p<.05. The results were as follows: 1) Statistically significant increase in ROM measurements of shoulder and elbow joints were seen with VR therapy with CIF compared to VR therapy and self upper extremity exercise (p<.05), whereas no significant increasing was noted for the wrist joint (p>.05). 2) Statistically significant increase in the MFT was seen with VR therapy with CIF compared with VR therapy and self upper extremity exercise (p<.05). 3) VR therapy with CIF also resulted in statistically significant increase in both activity of use (AOU) (p<.05) and quality of movement (QOM) (p<.05) on the MAL test when compared with VR therapy and self upper extremity exercise, respectively. In conclusion, VR therapy with CIF was more effective than conservative VR therapy and self upper extremity exercise in improving the upper extremity function in hemiplegic patients with chronic stroke.

• PNF and Movement
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• v.20 no.2
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• pp.147-156
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• 2022

Objective: Electrical stimulation is an assistive technology used to aid the recovery of upper limb use after stroke. The purpose of this systematic review was to determine the effects of electrical stimulation on upper extremity function in individuals with hemiparetic stroke and to develop an evidence base that supports the use of electrical stimulation for upper limb recovery after stroke. Design: A systematic review based on randomized controlled trials (RCTs). Methods: Studies published before April 20 2021 were collected for this review by searching PubMed, four other databases, and RCTs that reported the effects of electrical stimulation on upper extremity function in individuals with the characteristic stroke type. Information on the following parameters was extracted from each study: surname of first author, published year, country, participants, intervention, intervention's intensity, comparison, outcomes, additional therapy, and summary of results. This review also evaluated the bias within each study, including any selection bias, performance bias, detection bias, attrition bias, and reporting bias. Results: This review included five RCTs, and 208 stroke patients were included in the analysis. Stroke patients who underwent electrical stimulation showed significantly improved grip and pinch strengths, wrist range of motion, and basic daily living compared to those in the control group; however, there was no improvement in upper extremity function. Of the selected papers, 60% showed a "high risk" of performance bias, and 20% showed a "high risk" of detection bias. Conclusions: The results of this systematic review suggest that electrical stimulation provides some benefits to stroke patients, such as improved hand strength and range of motion. However, future studies are needed to provide clinical evidence of the effects of electrical stimulation on upper extremity function in stroke patients.

• Physical Therapy Korea
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• v.19 no.1
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• pp.86-93
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• 2012

The purpose of this study was to assess the feasibility of task-oriented arm training for chronic hemiparetic stroke patients. The experimental design in this study was the pre-test and post-test with control group for 4-week intervention. Thirty patients with chronic hemiparetic stroke were recruited from 2 rehabilitation units. The subjects were divided randomly into experimental and control groups. The experimental group conducted task-oriented approach, involving 3 subparts of upper extremity activities, and the control group involved in the general upper extremity exercises. Functional movements of the upper extremities were assessed using clinical measures, including the Fugl-Meyer Assessment-Upper Extremity Section, Box and Block Test, and Action Research Arm Test. The score of Fugl-Meyer Assessment showed greater increases in the experimental group than in the control group after training. The improvement in Box and Block Test between pre-test and post-test measurements was significantly greater after task-oriented arm training compared to general upper extremity exercises. Action Research Arm Test scores also improved after task-oriented arm training compared to exercises in the control group. The task-oriented arm training improves the gross and fine motor activities and encouraging the use of the paretic arm through activity dependent intervention expedites the recovery of functional activities in the upper extremities for chronic hemiparetic stroke.

• Therapeutic Science for Rehabilitation
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• v.9 no.2
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• pp.119-135
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• 2020

Objective : The purpose of this study was to investigate the effects of bimanual intensive training on Upper Extremity Function and activities of daily living in stroke patients. Methods : The subjects were 18 patients who were diagnosed with hemiplegic stroke. They were randomly assigned to bimanual intensive training group (n=9) and unilateral intensive group (n=9). Bimanual training group performed bimanual task and unilateral training group performed one hand task for 1 hour per session, 5 times a week, for 4 weeks. Chi-square test, Wilcoxon signed rank test, and Mann-Whitney U test were used for analysis. Results : The results showed that, upper extremity motor function and bimanual coordination were significantly improved in patients in the bimanual training group (p<.05). Additionally, the ratio of affected hand use and amount of use/quality of movement in the hemiplegic upper extremity in activities of daily living for patients in the bimanual training group were significantly improved (p<.05). Although the unilateral group improved motor upper extremity function and activities of daily living in the upper extremity (p<.05), it was not significantly different from that in the bimanual training group. In between-group comparison, bimanual coordination and ratio of the affected hand use in a day were significantly different (p<.05). Conclusion : It is reasonable to conclude that bimanual intensive training therapy is an effective intervention method to improve upper extremity motor function, and activities of daily living in stroke patients.

• The Journal of Korean Medicine
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• v.23 no.2
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• pp.180-189
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• 2002

Background and Purpose : The hemiplegic upper extremity is affected in many stroke patients, and recovery is often poor. The purpose of this study was to assess the efficacy of electroacupuncture (EA) in enhancing the upper extremity motor and functional recovery of ischemic stroke patients. Subjects and Methods : Forty ischemic stroke patients (the upper extremity Fugl-Meyer motor scale (FM) score lower than 46, lesion location within middle cerebral artery territory) within 2 weeks of stroke onset were randomly allocated to either an EA group that received EA treatment or a control group that received only routine ward care. The EA was applied at Quchi-Shousanli (LI11-LI10), Waiguan-Hegu (TE5-LI4) points on the hemiparetic side six times per week for 4 weeks. The frequency of stimulation was 25-50Hz and the intensity was set at a level sufficient to induce muscle contraction. EA treatment was given for 30 minutes and all patients of both groups received standard rehabilitation program. Outcomes were assessed, in a blind manner, before treatment began and at 4 weeks after treatment, with the FM, the Motor Power score (MP) for shoulder/elbow, and the subsection of the Modified Barthel Index (MBI) for drinking/feeding/dressing upper body/grooming. Results : These 2 groups had comparable clinical characteristics, lesion location, lesion size, and pretreatment impairment scores. By the end of treatment, the EA group showed significantly more improvement than the control group in the subsection of the FM for shoulder/elbow/coordination (6.4 vs. 3.7; P=0.047) and the MP for shoulder/elbow (5.3 vs. 3.3; P=0.008). The subsection scores of the MBI for drinking/feeding/dressing upper body/grooming were not significantly different between two groups. No adverse effects due to treatment were found Conclusion : These results suggest that EA enhances the upper extremity motor recovery of acute stroke patients. However, this study failed to demonstrate any significant functional benefit related with upper extremity. Future study should be carried out in a larger sample size and use the functional outcome measure that is more specific and sensitive to the upper extremity.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.84-90
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• 2021

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5-6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

• The Journal of the Korea Contents Association
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• v.14 no.3
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• pp.215-222
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• 2014

Recent years, mirror therapy or mirror neuron therapy has been used to improve neural damage of upper extremities among stroke patients. This systematic review was conducted to assess the clinical effect of mirror therapy used for the treatment of upper extremities for patients with stroke. After literature search, researchers selected for 9 randomized controlled clinical trial studies registered up to October 2013 based on PubMed database, using the following search terms: mirror therapy, mirror neuron, stroke, paresis, hemiplegia, upper extremity. There were significant improves of distal upper extremity function in the use of mirror therapy groups but the research using range of motion(ROM) as outcome measure. In conclusion, mirror therapy was more effective than conventional therapies or sham therapies for upper recovery of distal upper extremity function among stroke patients.