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Pectoralis major injuries are uncommon, typically affecting young male athletes engaging in high-intensity activities like weightlifting. A 62-yr-old man, who previously suffered a stroke leading to left hemiparesis, hemisensory loss, and spasticity, exhibited a left chest swelling during a rehabilitation clinic visit. Subsequent inquiries revealed his recent incorporation of a home-based pulley system for stretching exercises. On examination, the swelling was diffuse, firm, and nontender, located at the midclavicular line of his left chest, with a positive dropped nipple sign and loss of the left anterior axillary fold sign. An ultrasound confirmed a low-grade injury to the left pectoralis major tendon. Spastic muscle ruptures are extremely rare, with only three published reports linked to traumatic brain injury, multiple sclerosis, and spinal cord injury. Spasticity increases muscle vulnerability due to structural and mechanical changes to the skeletal muscles. This is the first report of a spastic pectoralis major tendon rupture and the first after a stroke. This case highlights the need for optimized multimodal spasticity management and reinforces the importance of comprehensive patient education on the safe execution of home-based stretching exercises. [ABSTRACT FROM AUTHOR]

Aim: Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP). Methods: We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children's facial expressions and affective states, indicative of their level of engagement during intervention sessions. Results: We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE. Conclusions: Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP. [ABSTRACT FROM AUTHOR]

Background: A given movement requires precise coordination of multiple muscles under the control of center nervous system. However, detailed knowledge about the changing characteristics of neuromuscular control for multi-muscle coordination in post-stroke hemiplegic patients during standing is still lacking. This study aimed to investigate the hemiplegia-linked neuromuscular dysfunction during standing from the perspective of multi-muscle dynamical coordination by utilizing a novel network approach – weighted recurrence network (WRN). Methods: Ten male hemiplegic patients with first-ever stroke and 10 age-matched healthy male adults were instructed to stand on a platform quietly for 30 s with eyes opened and eyes closed, respectively. The WRN was constructed based on the surface electromyography signals of 16 muscles from trunk, hips, thighs and calves. Relevant topological parameters, including clustering coefficient (C) and average shortest path length (L), were extracted to evaluate the dynamical coordination of multiple muscles. A measure of node centrality in network theory, degree of centrality (DC), was innovatively introduced to assess the contribution of single muscle in the multi-muscle dynamical coordination. The standing-related assessment metric, center of pressure (COP), was provided by the platform directly. Results: Results showed that the post-stroke hemiplegic patients stood with remarkably higher similarity of muscle activation and more coupled intermuscular dynamics, characterized by higher C and lower L than the healthy subjects (p < 0.05). The DC values and rankings of back, hip and calf muscles on the affected side were significantly decreased, whereas those on the unaffected side were significantly increased in hemiplegia group compared with the healthy group (p < 0.05). Without visual feedback, subjects exhibited enhanced muscle coordination and increased muscle involvement (p < 0.05). A decrease in C and an increase in L of WRN were observed with decreased COP areas (p < 0.05). Conclusions: These findings revealed that stroke-induced hemiplegia could significantly influence the neuromuscular control, which was manifested as more coupled intermuscular dynamics, abnormal deactivation of muscles on affected side and compensation of muscles on unaffected side from the perspective of multi-muscle coordination. Enhanced multi-muscle dynamical coordination was strongly associated with impaired postural control. This study provides a novel analytical tool for evaluation of neuromuscular dysfunction and specification of responsible muscles for impaired postural control in stroke-induced hemiplegic patients, and could be potentially applied in clinical practice. [ABSTRACT FROM AUTHOR]

This study investigated the treatment methods used by physical and occupational therapists for poststroke paretic upper limbs and the factors influencing their decision‐making processes. For the treatment methods of poststroke paretic upper limbs, the respondents were asked to select the most clinically used treatment according to the severity of the patient's condition. For the factors influencing their decision‐making processes, the respondents were asked to indicate each determinant using a 5‐point Likert scale (1 = no influence at all to 5 = very strong influence). Six hundred thirty‐eight therapists participated in this study. Exploratory factor analysis was used to assess the validity of the questionnaire. The findings indicated task‐specific training (N = 333, 52%) as the most popular for mild cases, followed by repetitive facilitative exercise (n = 143, 22.3%) for moderate cases and electrical stimulation (n = 246, 38.4%) for severe cases. This study revealed that evidence about treatment (very strong: n = 171 (27.0%), and strong: n = 287 (45.0%)) and patient preferences (very strong: n = 203 (31.8%), and strong: n = 251 (39.3%)) affected decision‐making significantly regarding treatment methods for the poststroke paretic upper limb. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting. Design: Pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation. Setting: Eight inpatient stroke units, UK. Participants: People within 14 days of stroke onset, presenting with lower limb hemiplegia. Interventions: Participants at control clusters received usual care. Participants at intervention clusters received rehabilitation using an Implicit Learning Approach (ILA); primarily consisting of reduced frequency instructions/feedback, and promotion of an external focus of attention. Video recording was used to understand the ability of intervention site therapists to adhere to the implicit learning principles, and to compare differences between groups. Measures: Ability to recruit and retain clusters/participants; suitability and acceptability of data collection processes; appropriateness of fidelity monitoring methods; and appropriateness of chosen outcome measures. Results: Eight stroke units participated, with four assigned to each group (intervention/control). Fifty-one participants were enrolled (intervention group 21; control group 30). Mean time since stroke was 6 days (SD 3.42; 0–14); mean age was 73 years (SD 14, 25–94). Of those approached to take part, 72% agreed. We found clear differences between groups with respect to the frequency and type of instructional statement. The ILA was acceptable to both patients and therapists. Conclusion: It is feasible to evaluate the application and effectiveness of motor learning principles within acute stroke rehabilitation, using a cluster randomised design. A larger study is required to evaluate the benefits of each approach; we provide a range of sample size estimates required for this. [ABSTRACT FROM AUTHOR]

Purpose: Cutting nails is an essential activity of daily living. In this study, a foot-operated safety nail clipper for people with stroke hemiplegia was developed in four phases using three-dimensional (3D) printing technology. Materials and methods: A user was identified to develop a foot-operated, safe nail clipper for people with stroke hemiplegia (Phase 1). A single user repeatedly used the technology to determine necessary improvements (Phase 2). Then, the usability was evaluated by four people with disabilities (Phase 3) before the clipper was manufactured at multiple institutions to determine its reproducibility (Phase 4). Results: The foot-operated safe nail clipper was upgraded during each phase. The Version 2.0 comprises twenty 3D printing materials and five readily-available materials. Conclusions: A foot-operated safety nail clipper was developed for people with stroke hemiplegia. The number of parts increased as the device was upgraded via the use of 3D printing and available materials. Based on a small-scale usability test, the device was best suited for people with stroke hemiplegia. The assistive device was shared with the assistive technology open platform as an open source. The four-phased process can be used to develop appropriate assistive technology devices through the Makers Movement in the future. IMPLICATIONS FOR REHABILITATION: People with stroke hemiplegia who have limited hand movement have difficulty cutting their nails independently. The foot-operated safety nail clipper for people with stroke hemiplegia was developed using the four phases methodology to help them cutting their nails: (1) Identifying the heavy user, (2) single scale, (3) small scale, and (4) multi-site reproducibility. We hope that the four-phased process of designing and developing appropriate assistive technology (AAT) devices presents insights that can be used to develop AAT devices through the Makers Movement in the future. AAT based on digital fabrication can be released to the public based on open source for people with disability in a low resourced environment, and the 3D modelling design can be easily modified according to individual needs. [ABSTRACT FROM AUTHOR]

Purpose: Stroke survivors may experience challenges in multiple domains (e.g., speech-language, dexterity, mobility) and pursue services from multiple professionals. Clinicians typically provide rehabilitation services in back-to-back sessions (multidisciplinary). Alternatively, two or more clinicians can co-treat a stroke survivor in one session (interdisciplinary). This pilot project examined task congruency in interdisciplinary stroke care. Method: A stroke survivor chronically challenged by non-fluent aphasia and right hemiparesis completed spoken-naming and upper-limb tasks simultaneously. The concurrent tasks were presented in two conditions: congruent (i.e., naming a pictured item while tracing the first letter of the name) and incongruent (i.e., naming a pictured item while tracing a non-symbolic shape). The sequence of the two conditions was: baseline probes, congruent practice (eight weeks), no practice (eight weeks), incongruent practice (eight weeks), and no practice (eight weeks). The entire treatment program was implemented as independent home practice utilizing a computer. Results: The participant made significant improvements in naming and clinically meaningful gains in arm movements during the congruent condition, but not during the incongruent condition. Conclusions: Data from this study suggest a potentially positive effect of simultaneous speech-language and upper-limb tasks. More research is warranted to further examine the role of task congruency in interdisciplinary stroke rehabilitation. IMPLICATIONS FOR REHABILITATION: Stroke survivors may chronically experience challenges in multiple domains (e.g., speech-language, dexterity, and mobility). Clinicians from multiple disciplines can collaborate and co-treat a stroke survivor within an interdisciplinary framework. During a co-treatment session, a stroke survivor can achieve greater gains by completing congruent tasks (e.g., saying the name of a pictured item while writing the first letter of the name with the impaired hand), compared to incongruent tasks (e.g., saying the name of a pictured item while tracing a non-symbolic shape with the impaired hand). [ABSTRACT FROM AUTHOR]

Background: The goal of post-stroke early rehabilitation is to regain ambulation, standing and balance. Objective: The purpose of this study was to investigate the effects of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance in patients with early subacute stroke. Design and setting: A randomized controlled trial was conducted at a university hospital. Methods: The study was included 52 hemiplegic hospitalized early suacute stroke patients. The experimental group (n: 30), was applied with vestibular and somatosensorial rehabilitation together with early rehabilitation. Vestibular exercises, included Cawthorne-Cooksey exercises, stimulate the vestibulo-ocular and vestibulo-spinal reflex. Somatosensory exercises, which included Frenkel exercises, stimulate the sensory proprioception and somatosensory systems. The control group (n: 22) patients with early subacute stroke were treated with the early rehabilitation program only. The balance parameters of the patients were evaluated with the Korebalance System, Functional Reach Test, Postural Assessment Scale for Stroke, and Functional Ambulation Scale. Results: The mean age of the patients was 67.32 ± 9.46 years, and the mean number of days that had passed since the stroke occurred was 17.90 ± 7.26. In calculating the balance scores, statistically significant differences were observed in the experimental and control groups, with a statistically greater improvement in the rehabilitation group. Statistically significant differences were determined between the groups in respect of the balance scores. Conclusions: Based on these findings, the use of vestibular and somatosensory rehabilitation can be recommended for better functioning of the compensatory mechanism of early subacute-stroke hemiplegic patients in early ambulation, and this can lead to considerably improved standing and dynamic upper and lower body balance. [ABSTRACT FROM AUTHOR]

The purpose of the rehabilitation program is to improve motor skills, coordination, sensory system, mobilization and other existing disorders to achieve activity of daily living (ADL). For a span of five months, beginning two months ago, the patient had been incapable of independent mobilization. Throughout this duration, he was confined to a bed and wheelchair, necessitating assistance from family members for movement, who would lift or carry him as necessary. Physical therapy as part of the multidisciplinary approach can provide core stability exercises, muscular facilitation and stimulation of motion of the upper and lower extremities, balance exercises and mobility exercises, as well as strengthening exercises with PNF facilitation and active stimulation techniques and using the patient's body weight as a training burden. Bobath approach and facilitation exercise can reduce spasticity by strengthening the antagonist muscles. This case report concludes that although physiotherapy is done late with strengthening exercise and core stability strengthening techniques, prone strengthening exercise, it can improve motor skills, coordination, which in turn will increase the patient's independence in carrying out functional activities and ADLs. [ABSTRACT FROM AUTHOR]

A 44-year-old woman suffered a carotid dissection causing a deep and superficial right middle cerebral artery stroke in October 2013, despite undergoing thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted. She then agreed to embark upon a guided self-rehabilitation contract (GSC). This GSC is a moral contract where the physician or therapist identifies specific muscles, particularly hypoextensible and disabling that act as antagonists to functional activities. The physician or therapist then teaches and prescribes quantified daily high-load self-stretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over 4 years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of the days. Each day, she practiced an average of 20 min of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81 ± 2 (mean ± SEM) min/day, and her mean number of active maximal efforts was 285 ± 78/day, for a total daily selfrehabilitation time of over 2 h a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left-hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity). The Modified Frenchay Scale assessment was video-recorded by the clinician at each visit, allowing qualitative and quantitative evaluation of the functional capacities. The two videos of the first and last clinic visits have been uploaded and are available. [ABSTRACT FROM AUTHOR]

Objective Hemiparesis occurs when a stroke causes paresis on the body, contralateral to the lesioned brain. In poststroke patients, upper limb impairments induce functional restrictions. Arm ability training is a unilateral treatment for mild arm paresis. We evaluated the effectiveness of arm ability training on functional mobility and dexterity in hemiparetic subjects Materials and Methods Forty-two hemiparetic subjects were selected by convenient sampling technique. The subjects were given 40 minutes of arm ability training and 20 minutes of conventional physiotherapy daily, five sessions a week extending for 4 weeks. Functional mobility was assessed through wolf motor function test (WMFT) and dexterity by box and block test (BBT). Results The pre- and post-test scores were evaluated by paired t -test using SPSS software after 4 weeks of training period subjects showed much improvement for the BBT (mean ± standard deviation [SD]: 20.31 ± 4.075 vs. 23.79 ± 4.291), functional ability of WMFT (mean ± SD: 45.38 ± 3.615 vs. 54.07 ± 3.790), time of WMFT (mean ± SD: 479.29 ± 117.79 vs. 434.4 ± 116.455), the strength of WMFT was (mean ± SD: 2.95 ± 0.731 vs. 3.9 ± 0.759), and grip strength of WMFT (mean ± SD: 2.9 ± 1.559 vs. 4.21 ± 1.539), all variables indicating statistical significance (p < 0.05). Conclusion Arm ability training proved effective in improving functional mobility and dexterity in hemiparetic subjects. [ABSTRACT FROM AUTHOR]