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Rehabilitation of an Aged Hemiplegic Patient  [cached]
Esma Ceceli
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2009,
Abstract: The incidence of hemiplegia due to cerebrovascular accident is increasing with aging and hemiplegia is the primary cause of long-term disability among the aged population. Comorbid diseases in aged patients have a negative influence on the therapy course. In this review comorbid problems and rehabilitation methods for aged hemiplegic patients were investigated. Turk J Phys Med Rehab 2009; 55 Suppl 2: 90-1.
Analysis of the sensory threshold between paretic and nonparetic sides for healthy rehabilitation in hemiplegic patients after stroke  [PDF]
Hye-Joo Jeon, Ju-Hyun Kim, Byong-Yong Hwang, Bokyung Kim, Junghwan Kim
Health (Health) , 2012, DOI: 10.4236/health.2012.412183
Abstract: The purpose of this study was to investigate the differences in the sensory threshold between the paretic and nonparetic sides of hemiplegic patients. 28 patients who were hemiplegic post-stroke (14 men and 14 women) participated in the electrical sensory and pain thresholds study; 22 patients who were hemiplegic post-stroke (13 men, 9 women) participated in a study measureing the sensory threshold with light touch. Electrical sensory and pain thresholds were measured in the forearm via transcutaneous electrical nerve stimulation. The light-touch threshold was measured in the forearm using monofilaments. The light-touch, electrical sensory, and pain thresholds for the paretic side were significantly higher than for the nonparetic side in our population, respectively. In both the nonparetic and paretic sides, the male group generally showed higher thresholds for pain and sensation than did the female group. These results suggest that the different evaluations of sensory thresholds performed in this study for healthy rehabilitation will be a valuable clinical tool in hemiplegic patients after stroke.
Auditory P300 as an Indicator in Effectiveness of Robot-Assisted Lower Limb Rehabilitation Training among Hemiplegic Patients after Ischemic Stroke  [PDF]
Yaning Zhao, Zhengwei Hao, Jianmin Li
Open Journal of Therapy and Rehabilitation (OJTR) , 2014, DOI: 10.4236/ojtr.2014.22012
Abstract: Background: Robot-assisted lower limb rehabilitation training in early stage could improve the limb function among hemiplegic patients caused by ischemic stroke. P300 potential changes have importantly clinical value for evaluating the improvement in nerve function during the training as one of the objective targets. Methods: Sixty hemiplegic patients after stroke were randomly divided into a Lokomat group (30 cases) and a control group (30 cases). The Lokomat group received Lokomat rehabilitation while the control group only received traditional rehabilitation. The gait parameters and the balance ability were evaluated by the K421GAITRite analysis system and the Berg Balance Scale (BBS); ERP components including N100, N200, P200 and P300 potential were evaluated by a muscle electric inducing potentiometer. Results: There were no significant differences in BBS and gait parameters (P > 0.05), as well as in amplitude and incubation periods (IP) (P > 0.05) between the two groups before training. After 8 weeks treatment, the total (48.88 ± 3.68), static (26.40 ± 3.14) and dynamic (22.64 ± 3.68) balance scores improved significantly; the pace (59.22 ± 4.67), stride length (19.04 ± 2.24), feet wide (98.02 ± 7.97) and walking velocity (84.86 ± 9.88) and IP of N200 and P300 shortened obviously and P300 amplitude increased significantly in robot group (P < 0.05). Conclusion: This demonstrated that robot-assisted lower limb rehabilitation training in early stage could improve the limb function among hemiplegic patients caused by ischemic stroke. P300 may be considered as an indicator of neurological function improvement and effective robot-assisted lower limb rehabilitation training.
Analysis of Problems Encountered during the Rehabilitation and Management of Hemiplegic Patients of Vascular Origin in Abidjan (Ivory Coast)
Berthe Assi, Ange-Michel Datie, Ernest Beugré Kouassi, Benjamin Manou, Béatrice Mansé Nandjui, Emmanuel Ses, Thérèse Sonan-Douayoua
African Journal of Neurological Sciences , 2002,
Abstract: Problemes Lies a la Prise en Charge Reeducative des Hemiplegies Vasculaires a Abidjan (Cote d\'Ivoire) (Francais) Background Cerebrovascular accidents may cause impairments of m otor, sensory and neuro psychological aspects. Rehabilitation is of paramount importance to reduce the physical and neuropsychological disabilities due to stroke. The outcome depends on the severity of the impairment, the cultural and economic factor. Objective To evaluate the current rehabilitation practice in Abidjan with the aim of identifying problems encountered and hence suggest the appropriate improvements. Methods This is a retrospective study concerning 176 cases of cerebrovascular accident recorded over a six years period in a rehabilitation department in Abidjan (C te d\'Ivoire). Demographic characteristics, clinical data, initial functional assessment, rehabilitation care and functional status one year after stroke were analysed. Results Most of the patients started rehabilitation care after discharge from the hospital, and 36.8 % of them were admitted after the C.V.A. 3 months. Initial functional assessment failed to assess neuropsychological impairments except aphasia. The rehabilitation care consisted only of physical therapy, but neither occupational nor speech therapy were available. One year after stroke, 62.02 % of the patients were still dependent for their daily living activities or unable to return to their previous work. Conclusion Lack of initial functional assessment, absence of early rehabilitation care, physical therapy, and speech therapy are the main obstacles identified. Moreover, sociocultural behaviour and scarcity of appropriate policies favourable to disabled persons limit these patients socioprofessional reintegration.
The effect of modified constraint induced movement therapy on quality and amount of upper limb movements in chronic hemiplegic patients in comparison with traditional rehabilitation
Khadijeh Otadi,mohammad Reza Hadian,Gholam Reza Olyaei,Bahram Rasoulian
Modern Rehabilitation , 2012,
Abstract: Background and Aim: Constraint-Induced Movement Therapy (CIMT) is a new intervention in chronic hemiplegic patients. The aim of present study is to quantify of quality of movement (QOM) and amount of movement (AOU) that assessed by motor activity log (MAL) after modified CIMT in comparison with traditional physiotherapy (TPT). Materials and Methods: Ten patients were randomized to modified CIMT or TPT group. Five patients received training of the more affected limb fort two hours daily, three times in a week during two months of treatment. The patients are encouraged to wear an arm- hand splint in less affected hand for five hours daily for maximal using of affected limb with shaping method. The patients in TPT group received physiotherapy treatment with same intensity with other group, for two hours daily during two months. Motor Activity Log (MAL) was used to determine QOM and AOU before- after two months treatment. Results: The data showed significant improvements in AOU and QOM in affected extremity that clarified by Wilcoxon test. Mann- Whitney test used for comparison between two groups, revealed significant difference in modified CIMT group (p=0.02). Conclusion: Although, modified CIMT was more effective than TPT in improving QOM and AOU but, TPT as an active rehabilitation can be effective on improving of these parameters. Key words: Stroke, Motor activity Log, Constraint induced movement therapy, Hemiplegia, Physiotherapy
Contralateral acupuncture versus ipsilateral acupuncture in the rehabilitation of post-stroke hemiplegic patients: a systematic review
Mi-kyung Kim, Tae-Young Choi, Myeong Soo Lee, Hyangsook Lee, Chang-ho Han
BMC Complementary and Alternative Medicine , 2010, DOI: 10.1186/1472-6882-10-41
Abstract: Seventeen databases were searched from their inceptions through June 2010. Prospective clinical trials were included if CAT was tested as the sole treatment or as an adjunct to other treatments for post-stroke rehabilitation and compared to IAT.Eight randomized clinical trials (RCTs) met our inclusion criteria. Four of them reported favorable effects of CAT compared to IAT for at least one outcome. A meta-analysis showed superior effects of CAT compared to IAT on recovery rate (n = 361; risk ratio (RR), 1.12; 95% confidence intervals (CIs), 1.04 to 1.22, P = 0.005). Subgroup analysis also showed favorable effects of using CAT on patients with cerebral infarction (n = 261; RR, 1.15; 95% CIs, 1.04 to 1.27, P = 0.006). Further analysis including patients with cerebral infarction and intracranial hemorrhage, however, failed to show these advantages (n = 100; RR, 1.11; 95% CIs, 0.85 to 1.46, P = 0.43).The results of our systematic review and meta-analysis suggest that there is limited evidence for CAT being superior to IAT in the treatment of cerebral infarction. The total number of RCTs included in our analysis was low, however, and the RCTs included had a high risk of bias. Future RCTs appear to be warranted.Stroke is one of the most common causes of death in the world. Despite the considerable benefits of organized stroke care, many stroke survivors remain moderately or severely disabled [1,2]. In Western medicine, no single form of complementary or alternative medicine (CAM) is commonly used to manage post-stroke rehabilitation or recovery [3]. In East-Asian countries, however, acupuncture and herbal medicine are widely used [3]. A recent survey reported that 46% of stroke patients use some form of CAM such as herbal medicine, acupuncture-type treatments or chiropractic treatments [4]. Contralateral acupuncture (CAT), also called opposite needling or crossing needling, is a needling technique where acupuncture points on the right side are selected for diseases on the
Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: Preliminary report
Chris A McGibbon, David E Krebs, Stephen W Parker, Donna M Scarborough, Peter M Wayne, Steven L Wolf
BMC Neurology , 2005, DOI: 10.1186/1471-2377-5-3
Abstract: We examined the relationship between lower extremity neuromuscular function and trunk control in 36 older adults with vestibulopathy, randomized to 10 weeks of either VR or TC exercise. Time-distance measures (gait speed, step length, stance duration and step width), lower extremity sagittal plane mechanical energy expenditures (MEE), and trunk sagittal and frontal plane kinematics (peak and range of linear and angular velocity), were measured.Although gait time-distance measures were improved in both groups following treatment, no significant between-groups differences were observed for the MEE and trunk kinematic measures. Significant within groups changes, however, were observed. The TC group significantly increased ankle MEE contribution and decreased hip MEE contribution to total leg MEE, while no significant changes were found within the VR group. The TC group exhibited a positive relationship between change in leg MEE and change in trunk velocity peak and range, while the VR group exhibited a negative relationship.Gait function improved in both groups consistent with expectations of the interventions. Differences in each group's response to therapy appear to suggest that improved gait function may be due to different neuromuscular adaptations resulting from the different interventions. The TC group's improvements were associated with reorganized lower extremity neuromuscular patterns, which appear to promote a faster gait and reduced excessive hip compensation. The VR group's improvements, however, were not the result of lower extremity neuromuscular pattern changes. Lower-extremity MEE increases corresponded to attenuated forward trunk linear and angular movement in the VR group, suggesting better control of upper body motion to minimize loss of balance. These data support a growing body of evidence that Tai Chi may be a valuable complementary treatment for vestibular disorders.Vestibulopathy decreases whole body dynamic postural control and causes functiona
Hemiplegic Shoulder Pain; Frequency and Related Factors  [PDF]
Ramazan KIZIL,Ozlem SENOCAK,Ozlem EL,Mehtap GOZUM
Journal of Neurological Sciences , 2009,
Abstract: Objective: To investigate the frequency of shoulder pain and related factors in hemiplegic patients.Methods: Thirtyeight patients having a stroke in past 18 months were included in the study. Demographic features, factors related to stroke, shoulder subluxation, shoulder pain and time passed until the beginning of shoulder pain were recorded.Results: The frequency of shoulder pain was 50%. In most of the patients ( 84%), shoulder pain occurred in first 8 weeks. Thromboembolic stroke, complete plegia at the beginning, low Brunnstrom motor recovery stage and shoulder subluxation were more prominent in patients with shoulder pain.Conclusions: Complete plegia at the begining and shoulder subluxation seem to be related factors in hemiplegic shoulder pain. In stroke patients, all preventive measures and early rehabilitation should be started.
STABILOMETRIC POSTURAL STEADINESS ANALYSIS OF POSTSTROKE HEMIPLEGIC PATIENTS
SOUVIK DAS,,D.N.TIBAREWALA
International Journal of Engineering Science and Technology , 2011,
Abstract: Postural steadiness characterizes the dynamics of the postural control system and postural sway associated with maintaining balance during quiet standing. It is reported that most of post stroke survivors with hemiplegia bear postural instability while compared to the age matched normal healthy subjects. Hemiplegia, resulting afterstroke, is a condition in which one-half of a patient's body is paralyzed. Hemiplegic patients show increased body sways, asymmetric weight bearing capacity and greater center of pressure excursions at the affected side during quiet standing compared to people without central nervous system disorders. The aim of this research paper is to quantify and characterize the postural steadiness of post stroke hemiplegic patients compared to agematched normal healthy control group using stabilometry that includes a force plate and identify the statistically significant variables using ANOVA test. Similar studies have rarely been performed in Indian health care system concerning the rehabilitation of post stroke survivors.
Usefulness of Liver and Spleen Acoustic Radiation Force Impulse (ARFI) for the Evaluation of Cirrhotic Patients
Luciana Barbosa, Catarina Oliveira, Alexandra Fernandes, Margarida Marques, Joao Pereira, Carlos Sofia, Filipe Caseiro-Alves, Maria José Noruegas
Open Access Library Journal (OALib Journal) , 2014, DOI: 10.4236/oalib.1100916
Abstract: Objective: To evaluate the correlation between ARFI and Child-Pugh classification. Secondary Aims: 1) To compare ARFI values (hepatic, splenic and spleno-hepatic index) from cirrhotic to normal population; 2) To correlate biochemical parameters of liver function and ARFI. Materials and Methods: 58 cirrhotic patients (referenced to US for surveillance or to clarify any hepatic decompensation) were included in this prospective study, as well as 38 healthy subjects who underwent ultrasonography for other reasons than hepatic evaluation. All had ARFI liver and spleen evaluation on ACUSON S2000 ARFI equipment. The best cut-off liver and spleen values for the diagnosis of cirrhosis in comparison to the normal subjects were determined using SPSS v20. Results: Mean liver ARFI values in controls and cirrhotic patients were respectively 1.18 ± 0.22 m/s and 2.93 ± 0.50 m/s. The ROC curve demonstrated an AUC 0.998 and the best cut-off was 1.89. Mean spleen ARFI values in controls and cirrhotic patients were respectively 2.60 ± 0.42 m/s and 3.03 ± 0.71. The ROC curve demonstrated an AUC 0.766 and the best cut-off was 2.73 m/s. The splenohepatic index showed a worse AUC than ARFI liver. A weak correlation was found between the ARFI liver and Child-Pugh. We found no statistically significant differences for spleen ARFI values and Child-Pugh. We found a statistically significant correlation between liver ARFI and bilirubin, ALKP, GGT, AST and AST/ALT ratio; and with spleen ARFI and ALKP and AST/ALT ratio. Conclusion: We showed that there is a tendency of higher levels of liver ARFI values for higher Child-Pugh classification suggesting a definite trend for higher values with more severe disease.
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