Effect of home-based rehabilitation of purposeful activity-based electrical stimulation therapy for chronic stroke survivors: a crossover randomized controlled trial.

IF 1.9 4区医学 Q4 NEUROSCIENCES Restorative neurology and neuroscience Pub Date : 2021-01-01 DOI:10.3233/RNN-211157

Seigo Minami, Yoshihiro Fukumoto, Ryuji Kobayashi, Hideaki Aoki, Tomoki Aoyama

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Abstract

Background: In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study.

Objective: The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial.

Methods: The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the Fugl-Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light).

Results: Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching.

Conclusions: The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors.

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有目的的以活动为基础的电刺激治疗对慢性脑卒中幸存者的家庭康复效果:一项交叉随机对照试验。

背景:在本试验中，我们结合有目的活动和电刺激治疗(PA-EST)的作用，在单例研究中促进慢性卒中幸存者严重偏瘫上肢向辅助上肢的过渡。目的:本研究的目的是在交叉随机对照试验中研究PA-EST对上肢运动功能的影响。方法:本研究纳入8例接受以家庭为基础的上门职业治疗的脑卒中幸存者(年龄:63.1±10.9岁)。卒中发生的平均时间为8.8±5.6年。所有参与者均有严重的上肢偏瘫，Fugl-Meyer上肢评估(FMA-U)评分为21.3±8.5。参与者被随机分配到A组或B组。A组接受PA-EST治疗3个月(第一阶段)，然后进行标准拉伸和运动3个月(第二阶段)，而B组的治疗顺序相反。为了避免结转效应，在第一阶段和第二阶段之间提供了1个月的洗脱期。分析采用重复测量的双向方差分析(ANOVA)。主要结局为FMA-U，次要结局为:运动活动日志(MAL;使用量(AOU)和运动质量(QOM))和目标实现尺度光(GAS-light)。结果:重复测量-方差分析显示FMA-U (F = 16.303, P = 0.005)、MAL AOU (F = 7.966, P = 0.026)、QOM (F = 6.408, P = 0.039)和GAS-light (F = 6.905, P = 0.034)的干预类型和时间之间存在显著的交互作用，其中PA-EST与标准拉伸相比显著改善运动功能和目标实现。结论:从FMA-U、MAL和GAS-light中可以看出，PA-EST在手部功能恢复方面可能比拉伸/运动有更大的效果。我们的研究结果表明，PA-EST是促进慢性中风幸存者使用严重偏瘫上肢的重要和有用的家庭康复计划。

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来源期刊

Restorative neurology and neuroscience 医学-神经科学

CiteScore

5.40

自引率

3.60%

发文量

审稿时长

>12 weeks

期刊介绍： This interdisciplinary journal publishes papers relating to the plasticity and response of the nervous system to accidental or experimental injuries and their interventions, transplantation, neurodegenerative disorders and experimental strategies to improve regeneration or functional recovery and rehabilitation. Experimental and clinical research papers adopting fresh conceptual approaches are encouraged. The overriding criteria for publication are novelty, significant experimental or clinical relevance and interest to a multidisciplinary audience. Experiments on un-anesthetized animals should conform with the standards for the use of laboratory animals as established by the Institute of Laboratory Animal Resources, US National Academy of Sciences. Experiments in which paralytic agents are used must be justified. Patient identity should be concealed. All manuscripts are sent out for blind peer review to editorial board members or outside reviewers. Restorative Neurology and Neuroscience is a member of Neuroscience Peer Review Consortium.