Motor Evaluation in Vascular Hemiplegia

Demeurisse, Guy; Demol, O; Robaye, Edmond

doi:10.1159/000115178

Cited by 730 publications

(418 citation statements)

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“…The principal clinical variables analyzed in this study were: (1) associated diseases (hypertension, diabetes, coronary disease, previous stroke); (2) presence of pain associated with spasticity (this was deemed to be present when the patients complained about pain; in the event of communication difficulty, body language suggestive of pain that was observed by the investigator or reported by the family was taken into account); (3) the time when the pain appeared, or when it was perceived, classified as pre-spasticity, concomitant with spasticity or post-spasticity; (4) previous stroke; (5) evaluation of tonus, as measured on the modified Ashworth scale 21 ; and (6) strength assessment, as measured using a muscle strength test 22 .…”

Section: Clinical Datamentioning

confidence: 99%

Predictive factors for spasticity among ischemic stroke patients

Moura

Fukujima

Aguiar³

et al. 2009

Arq. Neuro-Psiquiatr.

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-Spasticity is a determining for functional loss following ischemic stroke. Objective: To detect possible predictive factors for its occurrence. Method: Demographic, clinical and tomographic data on 146 stroke patients were analyzed. Results: Spasticity was noted more frequently among patients who underwent physiotherapy (p<0.0001; OR=19.4; 95% CI: 4.4-84.5), those who underwent such treatment for long periods (p=0.028; OR=4.80; 95% CI: 1.1-8.3) and those with manual work (p=0.041; OR=2.2; 95% CI: 1.02-4.6), lower income (p=0.038), pain complaints (p<0.0001; OR=107.0; 95% CI: 13.5-847.3), appearance of pain at the same time as spasticity (p<0.0001), previous vascular disease (p=0.001; OR=4.2; 95% CI: 1.7-10.3), muscle weakness (p<0.0001; OR=91.9; 95% CI: 12.0-699.4), extensive lesions as seen on tomography (p=0.01) and lesions affecting more than one cerebral lobe (p=0.018). Manual work had a relative risk of 2.9; previous stroke 3.9, and extensive lesion 3.6. Conclusion: Spasticity affected 25% of the patients, and was associated with: manual work, previous stroke, extensive lesions, decrease in individual income, underwent physiotherapy, underwent physiotherapy for longer period, pain complaints, the pain started simultaneously with the spasticity, presented changes in strength.KEY WORDS: spasticity, stroke, cerebral infarct, physiotherapy. Fatores preditivos para espasticidade após acidente vascular cerebralResumo -A espasticidade é fator determinante para perda funcional após o acidente vascular cerebral isquêmico (AVCI). Objetivo: Detectar possíveis fatores preditivos para a ocorrência da espasticidade. Método: Foram analisados dados demográficos, clínicos e tomográficos de 146 pacientes pós-AVCI. Resultados: Na análise univariada a espasticidade foi notada com maior freqüência em pacientes que realizaram fisioterapia (p<0,0001; OR=19,4; 95% CI: 4,4-84,5), com maior tempo de duração desse tratamento (p=0,028; OR=4,80; 95% CI: 1,1-8,3) e que realizavam trabalho braçal (p=0,041; OR=2,2; 95% CI: 1,02-4,6), renda menor (p=0,038), referência de dor (p<0,0001; OR=107,0; 95% CI: 13,5-847,3) e seu aparecimento simultâneo à espasticidade (p<0,0001), acidente vascular cerebral (AVC) pregresso (p=0,001; OR=4,2; 95% CI: 1,7-10,3), fraqueza muscular (p<0,0001; OR=91,9; 95% CI: 12,0-699,4), lesão tomográfica extensa (p=0,01) e lesão afetando mais de um lobo cerebral (p=0,018). Na análise de regressão multivariada a atividade braçal apresentou risco relativo de 2,9; acidente vascular cerebral prévio com risco relativo de 3,9 e lesão tomográfica extensa risco relativo de 3,6. Conclusão: A espasticidade afetou um quarto da população estudada e esteve associada ao trabalho braçal, AVC pregresso, lesões tomográficas extensas, diminuição da renda individual, realização de fisioterapia, realização de fisioterapia por um período maior, presença de dor, surgimento da dor simultânea à espasticidade e alteração da força. PALAVRAS-CHAVE: espasticidade, acidente vascular cerebral, infarto cerebral isquêmico, fisioterapia.

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Section: Clinical Datamentioning

confidence: 99%

Predictive factors for spasticity among ischemic stroke patients

Moura

Fukujima

Aguiar³

et al. 2009

Arq. Neuro-Psiquiatr.

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“…For other measures of upper limb function and impairment (grasp and gross subsections of the ARAT, 21 Frenchay Arm Test, 20 and the arm subsection of the Motricity Index, 19 the control group achieved statistically significantly higher scores than the intervention group. A greater proportion of participants failed the Star Cancellation Test 24 in the intervention group but this difference was not statistically significant.…”

Section: Resultsmentioning

confidence: 86%

“…These consisted of the ARAT 21 (4-week), Frenchay Arm Test, 20 Motricity Index, 19 Star Cancellation Test, 24 pain scales, 22,23 disability, and global health status (Nottingham E-ADL Index 28 ; Nottingham Health Profile) 29 (3 months), Oxford Handicap Scale, 30 and participant views regarding sNMES. The stroke unit staff was not informed of participants' randomization groups.…”

Section: Outcome Assessmentsmentioning

confidence: 99%

Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke

Church

Price

Pandyan

et al. 2006

Stroke

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Background and Purpose— Surface neuromuscular electrical stimulation (sNMES) after stroke aims to improve upper limb function and reduce shoulder pain, but current evidence of effectiveness is inconclusive. We have undertaken a randomized controlled trial to evaluate sNMES to the shoulder after acute stroke. Methods— One hundred seventy-six patients, within 10 days of stroke onset, were randomized to receive sNMES or placebo in addition to stroke unit care. The primary outcome measure was upper limb function measured by the Action Research Arm Test (ARAT) 3 months after stroke. Secondary outcome measures included other measures of upper limb function, upper limb impairment, pain, disability, and global health status. Outcome assessments were blinded. Results— There was no difference in arm function between groups in terms of the primary outcome measure. The median ARAT at 3 months was 50 in the intervention group and 55.5 in the control group ( P =0.068). Significant differences were seen at 3 months in favor of the control group for other measures of arm function and impairment: grasp and gross movement subsections of the ARAT, Frenchay Arm Test, and the arm subsection of the Motricity Index. Secondary analysis suggested that these differences were most marked in subjects with severe initial upper limb weakness. Conclusions— A 4-week program of sNMES to the shoulder after acute stroke does not improve functional outcome and may worsen arm function in severely impaired stroke patients. “Routine” use of sNMES to the proximal affected upper limb after acute stroke cannot be recommended.

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“…Secondary variables were the Rivermead Mobility Index (RMI) of 0 to 15, which includes 15 hierarchical items from turning over in bed to running that the patient could perform (score 1 point) or not (score 0 points) [21]; the 10 m test to assess the mean velocity (meters per second), where the patient walked 14 m twice at a self-selected speed and the time on 10 m was taken (an experienced therapist assisted the patient, if needed, and any applied technical aids were kept constant); the lower-limb Motricity Index (MI) of 1 to 100, which tested the muscle strength of ankle dorsiflexion, knee extension, and hip flexion [22]; and lower-limb muscle tone, in which five passive movements (ankle dorsiflexion, ankle eversion, knee flexion and extension, and hip flexion) were tested while the patient laid supine using the lower-limb Resistance to Passive Movement Scale of 0 to 20 [23].…”

Section: Assessmentmentioning

confidence: 99%

Robot-assisted practice of gait and stair climbing in nonambulatory stroke patients

Hesse

Tomelleri²,

Bardeleben³

et al. 2012

JRRD

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Abstract-A novel gait robot enabled nonambulatory patients the repetitive practice of gait and stair climbing. Thirty nonambulatory patients with subacute stroke were allocated to two groups. During 60 min sessions every workday for 4 weeks, the experimental group received 30 min of robot training and 30 min of physiotherapy and the control group received 60 min of physiotherapy. The primary variable was gait and stair climbing ability (Functional Ambulation Categories [FAC] score 0-5); secondary variables were gait velocity, Rivermead Mobility Index (RMI), and leg strength and tone blindly assessed at onset, intervention end, and follow-up. Both groups were comparable at onset and functionally improved over time. The improvements were significantly larger in the experimental group with respect to the FAC, RMI, velocity, and leg strength during the intervention. The FAC gains (mean +/-standard deviation) were 2.4 +/-1.2 (experimental group) and 1.2 +/-1.5 (control group), p = 0.01. At the end of the intervention, seven experimental group patients and one control group patient had reached an FAC score of 5, indicating an ability to climb up and down one flight of stairs. At follow-up, this superior gait ability persisted. In conclusion, the therapy on the novel gait robot resulted in a superior gait and stair climbing ability in nonambulatory patients with subacute stroke; a higher training intensity was the most likely explanation. A large randomized controlled trial should follow.Clinical Trial Registration: ClinicalTrials.gov; NCT001290611, "Robot-assisted Gait and Stair Practise"; http://www.clinicaltrials.gov.

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Motor Evaluation in Vascular Hemiplegia

Cited by 730 publications

References 1 publication

Predictive factors for spasticity among ischemic stroke patients

Predictive factors for spasticity among ischemic stroke patients

Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke

Robot-assisted practice of gait and stair climbing in nonambulatory stroke patients

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