Search

Objective: To investigate the performance of the less affected upper limb in people with stroke compared with normative values. To examine less affected upper limb function in those whose prestroke dominant limb became paretic and those whose prestroke nondominant limb became paretic., Design: Cohort study of survivors of chronic stroke (7.2±6.7y post incident)., Setting: The study was performed at a freestanding academic rehabilitation hospital., Participants: Survivors of chronic stroke (N=40) with severe hand impairment (Chedoke-McMaster Stroke Assessment rating of 2-3 on Stage of Hand) participated in the study. In 20 participants the prestroke dominant hand (DH) was tested (nondominant hand [NH] affected by stroke), and in 20 participants the prestroke NH was tested (DH affected by stroke)., Interventions: Not applicable., Main Outcome Measure: Jebsen-Taylor Hand Function Test. Data from survivors of stroke were compared with normative age- and sex-matched data from neurologically intact individuals., Results: When combined, DH and NH groups performed significantly worse on fine motor tasks with their nonparetic hand relative to normative data (P<.007 for all measures). Even the participants who continued to use their prestroke DH as their primary hand after the stroke demonstrated reduced fine motor skills compared with normative data. In contrast, grip strength was not significantly affected in either group of survivors of stroke (P>.140)., Conclusions: Survivors of stroke with severe impairment of the paretic limb continue to present significant upper extremity impairment in their nominally nonparetic limb even years after stroke. This phenomenon was observed regardless of whether the DH or NH hand was primarily affected. Because this group of survivors of stroke is especially dependent on the nonparetic limb for performing functional tasks, our results suggest that the nonparetic upper limb should be targeted for rehabilitation., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare participation and subjective experience of participants in both home-based multiuser virtual reality (VR) therapy and home-based single-user (SU) VR therapy., Design: Crossover, randomized trial., Setting: Initial training and evaluations occurred in a rehabilitation hospital; the interventions took place in participants' homes., Participants: Survivors of stroke with chronic upper extremity impairment (N=20)., Interventions: Four weeks of in-home treatment using a custom, multiuser virtual reality system (VERGE): 2 weeks of both multiuser (MU) and SU versions of VERGE. The order of presentation of SU and MU versions was randomized such that participants were divided into 2 groups, First MU and First SU., Main Outcome Measures: We measured arm displacement during each session (m) as the primary outcome measure. Secondary outcome measures include time participants spent using each MU and SU VERGE and Intrinsic Motivation Inventory scores. Fugl-Meyer Assessment of Motor Recovery After Stroke Upper Extremity (FMA-UE) score and compliance with prescribed training were also evaluated. Measures were recorded before, midway, and after the treatment. Activity and movement were measured during each training session., Results: Arm displacement during a session was significantly affected the mode of therapy (MU: 414.6m, SU: 327.0m, P=.019). Compliance was very high (99% compliance for MU mode and 89% for SU mode). Within a given session, participants spent significantly more time training in the MU mode than in the SU mode (P=.04). FMA-UE score improved significantly across all participants (Δ3.2, P=.001)., Conclusions: Multiuser VR exercises may provide an effective means of extending clinical therapy into the home., (Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the longevity and cumulative impact of multiple sessions of passive, cyclical stretching of the digits on hand function in subacute stroke survivors., Design: Before-after trial with intervention repeated on 3 consecutive days., Setting: Research laboratory., Participants: Individuals (N=27) with moderate to severe hand impairment, 2 to 6 months (subacute, n=12) and >7 months (chronic, n=15) poststroke., Interventions: Subjects wore an actuated glove orthosis that cyclically moved their fingers and thumb from a relaxed/flexed posture into neutral extension for 30 minutes on 3 consecutive days., Main Outcome Measures: Three hand-specific tasks from the Graded Wolf Motor Function Test, Box and Block Test (BBT), grip strength, and lateral pinch strength. Recordings were taken before stretching and at 3 time points, each separated by 30 minutes after completion of stretching on each day., Results: Significant improvement was observed immediately after the stretching for both groups. Improvements in the subacute group were largely maintained up to 1 hour poststretching, with significant carryover from day to day for some outcomes measures such as the BBT (P=.006) and grip strength (P=.012). In contrast, improvements after stretching for the chronic group were transient, with the changes largely dissipating over time and no significant cumulative effect across days., Conclusions: Cyclical stretching of the digits had a lasting and reinforcing effect on improving hand motor control for subacute stroke survivors. Incorporation of cyclical stretching before active hand therapy may prove to be a beneficial treatment for stroke survivors, especially during the subacute phase of recovery., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)