Reduced-Intensity Modified Constraint-Induced Movement Therapy Versus Conventional Therapy for Upper Extremity Rehabilitation After Stroke

Smania, Nicola; Gandolfi, Marialuisa; Paolucci, Stefano; Iosa, Marco; Ianes, Patrizia; Recchia, Serena; Giovanzana, Chiara; Molteni, Franco; Avesani, Renato; Paolo, Pietro Di; Zaccala, Massimo; Agostini, Michela; Tassorelli, Cristina; Fiaschi, Antonio; Primon, Daniela; Ceravolo, M. G.; Farina, Simona

doi:10.1177/1545968312446003

Cited by 65 publications

(97 citation statements)

References 44 publications

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“…It is important to note that two weeks of physical therapy alone are not able to induce a significant clinical improvement in the chronic phase of stroke (Kwakkel and Kollen, 2013), while in our study such an improvement was observed following two weeks of physical therapy coupled with cerebellar iTBS. This finding seems consistent with the findings of previous studies showing that motor improvements in chronic stroke patients are due not only to conventional therapy, but also to the application of rehabilitation programs, including innovative and adjunctive techniques such as constraint-Induced movement therapy (Smania et al, 2012) and robot-assisted therapy (Lo et al, 2010). The current study presents some limitations.…”

supporting

confidence: 75%

Cerebellar theta burst stimulation in stroke patients with ataxia

Bonnı̀

Ponzo

Caltagirone

et al. 2014

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SummaryEvidence for effective improvement of the symptoms of cerebellar stroke is still limited. Here, we investigated the effects of repetitive transcranial magnetic stimulation (rTMS) applied over the injured cerebellar hemisphere in six patients with posterior circulation stroke. We applied a two-week course of cerebellar intermittent theta burst stimulation (iTBS). Before and after the iTBS treatment, paired-pulse TMS methods were used to explore: i) the functional connectivity between the cerebellar hemisphere and the contralateral primary motor cortex (M1), by means of the cerebellar brain inhibition (CBI) protocol; and ii) the intracortical circuits in the contralateral M1, by means of the short intra-cortical inhibition (SICI) and intra-cortical facilitation (ICF) protocols. Patients were also evaluated using the Modified International Cooperative Ataxia Rating Scale (MICARS). Cerebellar iTBS induced a decrease in CBI and an increase in ICF at an interstimulus interval of 15 msec. These neurophysiological changes were paralleled by a clinical improvement, shown by the MICARS posture and gait subscale scores. Cerebellar iTBS could be a promising tool to promote recovery of cerebellar stroke patients. KEY WORDS: cerebellar stroke; theta burst stimulation; intracortical facilitation IntroductionPatients affected by ischemic or hemorrhagic stroke present motor disturbances such as ataxia, intention tremor, axial latero-pulsion and dysarthria. Ataxia is a common impairment after posterior circulation stroke Cerebellar theta burst stimulation in stroke patients with ataxia (PCS) involving the cerebellum or brainstem, and it restricts patients in their mobility and activities of daily living (Teasell et al., 2002). Various strategies have been suggested to improve the symptoms of cerebellar stroke, but the evidence of their effectiveness is still limited (Kruger et al., 2007). Repetitive transcranial magnetic stimulation (rTMS) has recently been proposed as a potentially useful method for modulating the excitability of cerebellothalamo-cortical (CTC) pathways, which could have a favorable effect on the cerebellar deficit (Koch, 2010). The current study was conducted to investigate the effects of a two-week course of cerebellar intermittent theta burst stimulation (iTBS) in a sample of six chronic stroke patients affected by PCS. This protocol is known to induce an increase in the excitability of the CTC pathways (Koch et al., 2008). Before and after the iTBS treatment we used paired-pulse TMS methods to explore: i) the functional connectivity between the affected cerebellar hemisphere and the contralateral motor cortex (M1), assessing cerebellar brain inhibition (CBI), and ii) the excitability of the contralateral M1, assessing short intra-cortical inhibition (SICI) and intra-cortical facilitation (ICF). In addition, all the patients were submitted to clinical evaluation: the Modified International Cooperative Ataxia Rating Scale (MICARS) was administered to investigate whether the iTBS protocol could improve ...

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supporting

confidence: 75%

Cerebellar theta burst stimulation in stroke patients with ataxia

Bonnı̀

Ponzo

Caltagirone

et al. 2014

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“…IIb B [688][689][690][691][692][693][694] Bilateral upper limb training has not been as well studied as CIMT. Two meta-analyses and more recent trials suggest that there is a small but measurable benefit compared with no intervention, but no consistent evidence of superiority over other task-specific training interventions has been shown.…”

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confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,161

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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“…References: (a) 33-35, 37, 38, 43, 45, 46, 49, 50, 57, 62, 64, 70, 71, 73, 80, 82; (b) 39, 42; (c) 55, 73; (d) 46, 82; (e) 46, 75; (f) 28; (g) 31, 33- 43, 45- 47, 51-56, 73, 75-78, 80-82; (h) 28; (i) 34, 37, 41, 43, 46, 52, 54, 55, 57, 61-64, 70-73, 75, 77, 78, 80-82; (j) 67, 69; (k) 28; (l) 34, 36, 37, 41, 43, 46, 49-52, 54, 55, 57, 61, 62, 64, 70-73, 75, 77, 78, 80-82; (m) 67, 69, 79; (n) 41, 47, 52, 54, 62-64, 66, 71; (o) 53, 81, 82; (p) 81, 82.…”

Section: Figurementioning

confidence: 99%

Constraint-induced movement therapy after stroke

Kwakkel¹,

Veerbeek²,

Wegen³

et al. 2015

The Lancet Neurology

437

304

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Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for treating stroke patients in the previous decades. This review describes the current evidence regarding: original CIMT and modified versions of CIMT (mCIMT). Meta-analysis showed strong evidence favoring both types of CIMT in terms of motor function, arm-hand activities and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas no evidence was found for constraining alone (Forced Use (FU) therapy). No evidence was found that type of CIMT, intensity of practice or timing did affect outcome. Although the underlying mechanism that drive (m)CIMT is still poorly understood, recent kinematic conducted studies suggests that improvements introduced by original CIMT or mCIMT are mainly based on adaptation by learning to optimize the use of intact end-effectors by selecting patients with some voluntary motor control of wrist and finger extensors post stroke.

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Reduced-Intensity Modified Constraint-Induced Movement Therapy Versus Conventional Therapy for Upper Extremity Rehabilitation After Stroke

Abstract: Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke.

Cited by 65 publications

References 44 publications

Cerebellar theta burst stimulation in stroke patients with ataxia

Cerebellar theta burst stimulation in stroke patients with ataxia

Guidelines for Adult Stroke Rehabilitation and Recovery

Constraint-induced movement therapy after stroke

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