Effectiveness of Proprioceptive Body Vibration Rehabilitation on Motor Function and Activities of Daily Living in Stroke Patients with Impaired Sensory Function

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Abstract

Stroke patients experience impaired sensory and motor functions, which impact their activities of daily living (ADL). The current study was designed to determine the best neurorehabilitation method to improve clinical outcomes, including the trunk-impairment scale (TIS), Berg balance scale (BBS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI), in stroke patients with impaired sensory function. Forty-four stroke survivors consistently underwent proprioceptive body vibration rehabilitation training (PBVT) or conventional physical therapy (CPT) for 30 min/session, 5 days a week for 8 weeks. Four clinical outcome variables–the FMA, TIS, BBS, and MBI–were examined pre- and post-intervention. We observed significant differences in the FMA, BBS, and MBI scores between the PBVT and CPT groups. PBVT and CPT showed significant improvements in FMA, BBS, TIS, and MBI scores. However, PVBT elicited more favorable results than CPT in patients with stroke and impaired sensory function. Collectively, this study provides the first clinical evidence of optimal neurorehabilitation in stroke patients with impaired sensory function.

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An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

Ralph Sacco, Scott E Kasner, Joseph P Broderick … (2013)

Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

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The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties

Cynthia J. Danells, Sandra Black, David J Gladstone (2016)

Measurement of recovery after stroke is becoming increasingly important with the advent of new treatment options under investigation in stroke rehabilitation research. The Fugl-Meyer scale was developed as the first quantitative evaluative instrument for measuring sensorimotor stroke recovery, based on Twitchell and Brunnstrom's concept of sequential stages of motor return in the hemiplegic stroke patient. The Fugl-Meyer is a well-designed, feasible and efficient clinical examination method that has been tested widely in the stroke population. Its primary value is the 100-point motor domain, which has received the most extensive evaluation. Excellent interrater and intrarater reliability and construct validity have been demonstrated, and preliminary evidence suggests that the Fugl-Meyer assessment is responsive to change. Limitations of the motor domain include a ceiling effect, omission of some potentially relevant items, and weighting of the arm more than the leg. Further study should test performance of this scale in specific subgroups of stroke patients and better define its criterion validity, sensitivity to change, and minimal clinically important difference. Based on the available evidence, the Fugl-Meyer motor scale is recommended highly as a clinical and research tool for evaluating changes in motor impairment following stroke.

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Neuroplasticity in the context of motor rehabilitation after stroke.

Michael A Dimyan, Leonardo Cohen (2011)

Approximately one-third of patients with stroke exhibit persistent disability after the initial cerebrovascular episode, with motor impairments accounting for most poststroke disability. Exercise and training have long been used to restore motor function after stroke. Better training strategies and therapies to enhance the effects of these rehabilitative protocols are currently being developed for poststroke disability. The advancement of our understanding of the neuroplastic changes associated with poststroke motor impairment and the innate mechanisms of repair is crucial to this endeavor. Pharmaceutical, biological and electrophysiological treatments that augment neuroplasticity are being explored to further extend the boundaries of poststroke rehabilitation. Potential motor rehabilitation therapies, such as stem cell therapy, exogenous tissue engineering and brain-computer interface technologies, could be integral in helping patients with stroke regain motor control. As the methods for providing motor rehabilitation change, the primary goals of poststroke rehabilitation will be driven by the activity and quality of life needs of individual patients. This Review aims to provide a focused overview of neuroplasticity associated with poststroke motor impairment, and the latest experimental interventions being developed to manipulate neuroplasticity to enhance motor rehabilitation.