The effect of repetitive rhythmic precision grip task-oriented rehabilitation in chronic stroke patients

Abstract

Most chronic stroke patients present with difficulty in the manipulation of objects. The aim of this study was to test whether an intensive program of precision grip training could improve hand functioning of patients at more than 6 months after a stroke. This was a cross-over study; hence, at inclusion, the patients were randomly divided into two groups: one group started with the bilateral movement therapy and the other group started with the unilateral movement therapy. The patients were assessed on four separate occasions across a 12-week period: (a) at inclusion in the study, (b) 4 weeks later, immediately before the first rehabilitation session, (c) after 4 weeks of one therapy, and (d) after a further 4 weeks of the other therapy. Ten patients completed two consecutive 4-week sessions (1 h, 3 days/week) of therapy. The therapy comprised unilateral and bilateral repetitive grip-lift task-oriented rehabilitation with rhythmic auditory cueing. The grip-lift force coordination, digital dexterity, manual ability, and the level of satisfaction (with activities and participation) were assessed. A one-way repeated-measure analysis of variance across the four evaluations did not detect any objective improvement in the measured variables after 8 weeks of specific intensive training. Precision grip training was shown to not generate significant improvement in the grip-lift task, digital dexterity, manual ability, or satisfaction in chronic stroke patients.

Gamma absolute power reveals activation of motor areas after hand immobilization

“…This therapeutic approach, named constraint-induced movement therapy, is supported by the pattern of cortical activation due contralateral limb restriction. 31,32 This concept is reinforced by our findings regarding a larger increase of the gamma band absolute power at the F4 derivation; this shows that the homologous right side cortical region is activated to compensate for the left side region, which is responsible for the immobilized right hand. It thus appears that cortical reorganization did occur in spite of the fact that immobilization only lasted for 48 hours.…”

Cognitive-Motor Interference While Grasping, Lifting and Holding Objects

“…Indeed, it could well be that following such a lesion, precision grip is even more dependent on cognitive resources. This is of particular importance as previous studies have largely failed to demonstrate decisive changes in precision grip following specific rehabilitation procedures, although patients often report a subjective improvement of their ability to conduct daily-life activities involving the manipulation of objects [26]. Therefore, it would be of interest to examine whether these rehabilitation procedures reduce the impact of a concurrent cognitive task on precision grip, which would suggest that the rehabilitation reduced the amount of cognitive resources required for object manipulation [20,45].…”

“…The device was instrumented with full Wheatstone Bridges incorporating three strain gauges load sensors allowing to measure the force perpendicular to each contact surface (grip force s , GF left and GF right) as well as the tangential force applied on the object (load force, LF) [26]. It was calibrated up to a full scale of 30 N in each direction and demonstrated a maximum nonlinearity of 0.70 % for LF and 0.35 % for GF.…”

New design of home-based dynamic hand splint for hemiplegic hands: a preliminary study

“…A rehabilitation program is often designed by a physical therapist in a hospital. Repetitive-movement training can enhance the brain and neural activation links and regenerate the injured parts of the brain 6 ) . Stroke patients undergo repetitive training during the rehabilitation program; however, limited therapy time often results in an ineffective rehabilitation, especially when an extension of the training program is lacking at home 7 , 8 ) .…”