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Introduction：There are few detailed evaluations of upper extremity function in Japan, especially for cervical spinal cord injury (CSCI). The capabilities of upper extremity test (CUE-T) evaluates upper extremity function, is specialized for CSCI, and is internationally used；however, there are few reports from Japan. This study verified the reliability, validity, and responsiveness of the CUE-T in Japan.Methods：We determined the interrater reliability, internal consistency, weighted kappa coefficient, intraclass correlation coefficient, and Cronbach's α coefficient for acute and chronic CSCI. The correlation coefficient with other evaluations was calculated and validated. Furthermore, the evaluation was performed twice at regular intervals, and the correlation between the change in CUE-T and other evaluations and the sensitivity to change using the standardized response mean (SRM) were verified.Results：The weighted kappa coefficient was 0.61-1.00, intraclass correlation coefficient was ≥0.9, and Cronbach's α coefficient were ≥0.9. The CUE-T and other evaluation methods showed moderate to strong correlations. In addition, the amount of change between CUE-T and the other evaluations were significantly correlated, and the SRM was ≥0.8.Discussion：In Japan, the CUE-T has been suggested to have good reliability, validity, responsiveness, and interpretability as an evaluation of upper extremity function in patients with CSCI. We will continue to verify the interpretability of the CUE-T and consider its dissemination in Japan.
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Introduction：There are few detailed evaluations of upper extremity function in Japan, especially for cervical spinal cord injury (CSCI). The capabilities of upper extremity test (CUE-T) evaluates upper extremity function, is specialized for CSCI, and is internationally used；however, there are few reports from Japan. This study verified the reliability, validity, and responsiveness of the CUE-T in Japan.Methods：We determined the interrater reliability, internal consistency, weighted kappa coefficient, intraclass correlation coefficient, and Cronbach's α coefficient for acute and chronic CSCI. The correlation coefficient with other evaluations was calculated and validated. Furthermore, the evaluation was performed twice at regular intervals, and the correlation between the change in CUE-T and other evaluations and the sensitivity to change using the standardized response mean (SRM) were verified.Results：The weighted kappa coefficient was 0.61-1.00, intraclass correlation coefficient was ≥0.9, and Cronbach's α coefficient were ≥0.9. The CUE-T and other evaluation methods showed moderate to strong correlations. In addition, the amount of change between CUE-T and the other evaluations were significantly correlated, and the SRM was ≥0.8.Discussion：In Japan, the CUE-T has been suggested to have good reliability, validity, responsiveness, and interpretability as an evaluation of upper extremity function in patients with CSCI. We will continue to verify the interpretability of the CUE-T and consider its dissemination in Japan.
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Shoulder subluxation, a risk factor for hemiplegic shoulder pain, is an important target to treat during stroke rehabilitation. Calcific tendinitis is an idiopathic condition characterized by calcium deposition over fibrocartilaginous tenocyte metaplasia that inhibits the efficacy of occupational therapy for the treatment of stroke. To provide comprehensive occupational therapy, we provided repetitive facilitative exercise under continuous neuromuscular electrical stimulation and robot-assisted training, while controlling pain, for fourteen weeks in a case of convalescent post-stroke hemiplegia with rotator cuff calcific tendinopathy and shoulder subluxation. As a result, this comprehensive occupational therapy not only improved upper-extremity function and the ability to manipulate objects, but also reduced calcified deposits. Shoulder subluxation with calcifying tendinitis is rare. There is a possibility that calcified deposits below the acromion may push down the humeral head. Sufficient rest and non-steroidal anti-inflammatory drugs during the acute inflammatory stage may be helpful for the melting and resorption of calcified deposits. In addition, the appropriate and comprehensive occupational therapy may contribute to the effects of upper-extremity hemiplegia with calcific tendinitis and shoulder subluxation.
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Objective:To observe the measurement of Simple Test for Evaluating Hand Function (STEF) in Chinese, and compared to that of Japanese. Methods:From May to June, 2020, 130 healthy individuals were tested with the toolkit and instructions of STEF, and the result was compared with Japanese data with one-sample t-test, and adjusted. Results:Among the ten items performed on the right side of the STEF, nine items, except item four (middle-sized cubes), were significantly different from those of Japanese (|t| > 1.760, P < 0.05). Among the ten items performed on the left side of STEF, seven items, except item four (middle-sized cubes), item seven (vinyl sheets) and item eight (iron circular plates), were significantly different from those of the Japanese (|t| > 2.257, P < 0.001). Conclusion:There is significant difference in the test results of STEF between Chinese and Japanese samples, and need to be adjusted.
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OBJECTIVE@#To compare the clinical therapeutic effect on post-stroke spastic paralysis of the upper extremity between the combination of kinematic-acupuncture therapy and rehabilitation training and the combined treatment of the conventional acupuncture with rehabilitation training.@*METHODS@#A total of 60 patients of post-stroke spastic paralysis of the upper extremity at the non-acute stage were randomized into an observation group (30 cases) and a control group (30 cases, 1 case dropped off). On the base of the routine western medication and rehabilitation treatment, the kinematic-acupuncture therapy was added in the observation group and the conventional acupuncture was used in the control group. Baihui (GV 20), Dazhui (GV 14), Jiaji (EX-B 2) from T to T, Tianzong (SI 11), Jianzhen (SI 9), Jianyu (LI 15) and Quyuan (SI 13) were selected in both groups. The treatment was given once daily and the treatment for 14 days was as one course. The one course of treatment was required in this research. Separately, before treatment and in 7 and 14 days of treatment, the score of simplified Fugl-Meyer scale of the upper extremity (FMA-UE), the grade of the modified Ashworth scale (MAS) and the score of the modified Barthel index scale (MBI) were compared between the two groups.@*RESULTS@#Compared before treatment, in 7 and 14 days of treatment, FMA-UE score was increased obviously in either group (<0.01). In 14 days of treatment, FMA-UE score in the observation group was higher than that in the control group (<0.05). In 7 and 14 days of treatment, MAS grades of shoulder joint, elbow joint, wrist joint and metacarpophalangeal joint were all improved markedly in the two groups (<0.05). Compared with the grades in 7 days of treatment, MAS grades of elbow joint and metacarpophalangeal joint were improved markedly in 14 days of treatment in the two groups (<0.05). Compared with the control group, MAS grades of elbow joint and metacarpophalangeal joint were improved more markedly in the observation group in 14 days of treatment (<0.05). Compared with the score before treatment, MBI score was increased in 7 and 14 days of treatment respectively in the observation group (<0.05, <0.01). In 14 days of treatment, MBI score was increased in the control group (<0.01).@*CONCLUSION@#For the patients with post-stroke spastic paralysis of the upper extremity at the non-acute stage, the combined treatment with kinematic-acupuncture therapy and rehabilitation training obviously improves the motor function of the upper extremity and the muscle tone of elbow joint and metacarpophalangeal joint. The therapeutic effect of this combination is better than that of the combined treatment of the conventional acupuncture with rehabilitation training. Additionally, this combined therapy improves the ability of daily life activity.
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Humans , Acupuncture Therapy , Biomechanical Phenomena , Muscle Spasticity , Therapeutics , Stroke , Therapeutics , Stroke Rehabilitation , Treatment Outcome , Upper ExtremityABSTRACT
Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.
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Objective To investigate the effect of graded motor imagery ( GMI) therapy combined with rou-tine occupational therapy on the recovery of upper extremity function after stroke. Methods Thirty stroke survivors who met inclusion criteria were randomly assigned to a control group ( n=15) or a GMI group ( n=15) . The control group received routine medication, conventional physical therapy and routine occupational therapy ( one hour a day) , while the GMI group received 30 minutes of routine occupational therapy and 30 minutes of graded motor imagery therapy every day in addition to conventional medication and physical therapy. Before and after four weeks of treat-ment, the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities ( FMA-UE) , the Box and Block Test ( BBT) and Brunnstrom arm and hand staging. Surface electromyography of the biceps brachii and triceps brachii was performed as the affected elbow flexed and stretched in maximum isometric contrac-tions, and the co-contraction ratios ( CRs) were calculated. Results After the treatment, the average FMA-UE score, Brunnstrom arm and hand stage, BBT and CR scores in both groups had improved significantly. The average improvement in the GMI group was significantly greater than in the control group. Conclusions Graded motor im-agery therapy can significantly promote motor recovery of the upper extremities of hemiplegic patients after a stroke.
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Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.
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Background:This study was to measure the upper extremity performance time on Nine Hole Peg Test (NHPT) in two different sitting orientations relative to vertical plane. Aim:To find out the influence of sitting orientation on upper extremity motor function using NHPT. Methods:100 children with the mean age 11year (53 male, 47 female) partici-pated in the study. Children were selected according to inclusion and exclusion criteria. Age groups were re-established for data representation purposes as: 5-7, 8-10, 11-13, 14-16. Each one was briefly interviewed prior to the test, procedure explained and statistical analysis was done for the final results. Results: Gender wise relation revealed non-significant difference in performance time on NHPT in 900 upright and 150 anterior sitting orientation. Performance time on NHPT with dominant and non-dominant hand in 900 upright & 150anterior sitting orientation shows significant difference. The mean performance time with dominant hand on NHPT was slightly lesser in 150anterior sitting orientation than 900upright orientations. According to age wise distribution the performance time on NHPT reveals that as the age increases the performance time decreases from 5-11 year. The performance time be-comes constant from 11-16 years of age. Conclusion:Result of this study suggest that trunk orientation does not affect upper extremity performance on NHPT. As it implies that 150anterior trunk orientation is equivalent to upright sitting orientation. Hence both the trunk orientation can be used to train patients for upper extremity hand function.
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Objective To explore the effect of intensive upper limb therapy assisted by a hand robot on motor function after stroke and performance in the activities of daily living.Methods Thirty-two hemiplegic stroke survivors were randomly divided into a conventional rehabilitation group (group A,n =10),a robot-assisted therapy group (group B,n=10),and a robot-assisted intensive therapy group (group C,n=12).The three groups all received routine drug therapy and daily 40 min sessions of conventional rehabilitation training 5 days a week for 4 weeks.Those in groups B and C were additionally provided with 20 min of robot-assisted therapy or 40 min of more intensive robot-assisted intensive therapy respectively.Before and after the intervention,the 3 groups were assessed using the Fugl-Meyer assessment for the upper extremities (FMA-UE),the action research arm test (ARAT) and the modified Barthel Index (MBI).Results No significant differences were observed among the 3 groups in any of the measurements before the treatment.In each group the average FMA-UE,MBI and ARAT scores had increased significantly after four weeks of treatment.The improvements in the average FMA-UE and ARAT scores were more significant in group B than in group A,while the FMA,MBI and ARAT scores suggested a significantly greater improvement in group C than in group B.Conclusion Robot assistance can help to improve upper extremity motor function after a stroke.It also has an obvious effect on improving performance in the activities of daily living.
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Objective To explore the effects of action observation therapy on upper-extremity motor function after ischemic stroke and on the motor cortex using functional magnetic resonance imaging (fMRI).Methods Forty patients with ischemic stroke were randomly assigned to an observational group (n =20) or a control group (n =20).Both groups received conventional rehabilitation,while the observational group was additionally provided with action observation therapy for 8 weeks.Both groups were assessed using the Fugl-Meyer assessment (FMA) and the Barthel index (BI) before and after the 8 weeks of treatment and functional magnetic resonance imaging was performed before treatment.Two months after the treatment,nine patients of the experimental group and 8 of the control group who continued to receive their respective treatments after discharge were again assessed using functional magnetic resonance imaging.Results After the treatment the average FMA score and BI score of both the observational group and the control group had increased significantly.The increase in the average FMA score of the observational group was significantly greater than that of the control group.However,there was no significant difference between the two groups in the increases in BI score after 8 weeks of treatment.The fMRI results showed that there was a significantly greater rise in activity in the bilateral precentral gyrus,parietal lobe and the supplementary motor area of the patients in the observational group after the treatment compared with the control group.Conclusion Action observation therapy can improve upper extremity motor function and performance in the activities of daily living after ischemic stroke and induce changes in the excitability of the cerebral motor cortex.
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Performance of upper extremity function and movement sequence is influenced by postural control. Motor disorders lead to deficits in postural control, which subsequently may lead to postural instability of children with cerebral palsy (CWCP). This will limit their upper extremity activity performance. Management strategies help to support and enhance the CWCP’s upper extremity function so that they may engage with the activities of daily living. The purpose of this paper is to review previous literature on the influence of postural control towards upper extremity function. Literature searches were conducted in various electronic databases, including ProQuest, Science Direct, Springer Link, Sage, Wiley Online Library, and Google Scholar using specific key terms. Search terms included children with cerebral palsy; postural control; postural adjustments; upper extremity function; reaching and sitting and from references of retrieved articles. Nineteen journal articles published between 2000 and May 2015 were found. Most search results consisted of experimental studies, while others are reviews, case studies, and cross-sectional studies. Findings show that, postural control has a major influence on upper extremity function. In conclusion, it is necessary to highlight the importance of both factors to the CWCP parents or caregivers, as understanding and awareness on this matter is still inadequate in the community. Hence, a study is needed on the awareness of the postural control influence on upper extremity function among caregivers, as well as examining the implementation of management strategies in community settings.
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Cerebral PalsyABSTRACT
Objective To investigate the effects of playing virtual reality games on the recovery of hemiplegic upper extremities after stroke.Methods Thirty stroke patients with hemiplegic upper extremities were randomly assigned to a treatment group (n=15) or a control group (n=15).Both groups received routine medication and conventional physical therapy,while the treatment group was additionally given (Nintendo) gaming-based virtual reality therapy.Before and after 2 weeks of treatment,the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities (FMA-UE),Brunnstrom staging and co-contraction ratios (CRs).Surface electromyogram signals from the biceps brachii and triceps brachii were also recorded during maximum isometric voluntary flexion and extension of the affected elbow.Results No significant differences in any of the measurements were observed between the 2 groups before or after the intervention.Both groups demonstrated significant increases in their average FMA-UE score,Brunnstrom staging and CRs.Conclusions Virtual reality gaming using a Wii controller is as effective as conventional therapy in enhancing upper extremity motor function and elbow flexion and extension after stroke.
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ObjectiveTo investigate the effect of acup point injection and rehabilitation techniques on recovery of upper limb function and activities of daily life (ADL) in patients with shoulder-hand syndrome (SHS) after cerebral infarction.Methods Ninety-six patients with SHS after cerebral infarction admitted to Jiuquan City Traditional Chinese Medicine Hospital and Jiuquan City People's Hospital from January 2014 to February 2016 were enrolled, and they were randomly assigned to observation group (56 cases) and control group (40 cases). The patients in the two groups were given the same routine comprehensive cerebral infarction treatments and rehabilitation technological training. In the control group, additionally intermediate frequency physiotherapy was used, while in the observation group, acupuncture and acupoint injection of salvia miltiorrhiza and ligustrazine were added. The patients in two groups were treated consecutively for one month, afterwards, the upper limb motor function, ADL, shoulder joint pain, degree of swelling and range of motion were assessed, and the clinical effects were observed.Results After treatment, the modified Fugl-Meyer motor function score (FMA), modified barthel index (MBI) and the ranges of voluntary activities of shoulder abduction, adduction, flexion, extension, internal rotation and external rotation in patients of two groups were significantly increased than those before treatment; the pain visual analog scale (VAS) and the edema volume difference in observation group were lower than those in the control group, and after treatment, the changes of above indexes were more significant in the observation group than those in the control group [FMA: 70.10±6.38 vs. 41.76±18.69, VAS: 2.00±1.37 vs. 5.00±1.25, MBI: 75.17±3.51 vs. 51.56±2.12, edema volume difference (cm3): 2.13±2.05 vs. 5.75±1.17, flexion: (153.1±6.7)° vs. (56.0±10.9)°, extension: (39.6±5.8)° vs. (17.2±6.7)°, abduction:(168.1±9.6)° vs. (52.1±8.9)°, adduction: (52.1±3.6)° vs. (21.8±4.3)°, external rotation: (49.8±7.6)° vs. (23.2±5.2)°, internal rotation: (107.0±8.5)° vs. (51.2±6.1)°], the total effect in observation group was significantly higher than that in the control group [91.1% (52/56) vs. 70.0% (28/40),P < 0.05].Conclusions Acupuncture and acupoint injection combined with three-level therapeutic regimen of rehabilitation technological training for treatment of shoulder-hand syndrome after cerebral infarction can reduce the patient's pain and edema, and improve upper limb motor function and activities of daily living.
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Background: Over 50% of patients with upper limb paresis resulting from stroke face long term impaired arm function and ensuing disability in daily life. The incidence of stroke increases dogmatically with age, doubling in the decade after 65 years of age. Early rehabilitation treatment in the first phase of stroke is currently advice in clinical guidelines and little evidence is available on such treatment for improving arm/hand function in the same period. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. Aim: This study aimed to evaluate a new therapy for improving upper extremity function in sub-acute stroke patients based on mental practice theories and funtional task-oriented training, and to study the predictors for a positive treatment result. Material and methods: 30 sub-acute stroke patients with upper limb paresis were selected by simple random sampling in this study. The experimental group undertook 12 week, individually tailored therapy regime focused on improving upper extremity function using mental practice . primary outcome measures assessed upper extremity functioning with Action Research Arm Test, Fugl Meyer Test, and Modified Asworth Scale. ANOVA was used in this study. Null hypothesis with alpha level was set at 0.05. Conclusion: Mental imagining training resulted in significant improvement in upper extremity function in sub acute stroke patient. However the improvement obtained in upper extremity function found no significant difference after mental imagining training between the groups.
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@#Objective To investigate the effects of mirror visual feedback (MVF) and electromyographic biofeedback (EMGBF) on upper extremity function in hemiplegic patients after stroke based on task-oriented training. Methods 90 patients with hempiplegia after stroke were randomly divided into control group (n=30), EMGBF group (n=30) and MVF group (n=30). All patients accepted routine rehabilitation and task-oriented training once a day for 8 weeks. The EMGBF group also accepted EMGBF, and the MVF group accepted MVF in addition. They were assessed with Fugl-Meyer Assessment (FMA) and the Upper Extremity Function Test (UEFT), and their integrated electromyogram (iEMG) of affected upper extremities were recorded before and after treatment. Results All the groups improved in scores of FMA and UEFT, as well as the iEMG after treatment (P<0.05), and ranked as the MVF group, the EMGBF group and the control group from improving more to less (P<0.05). Conclusion Mirror visual feedback combined with electromyographic biofeedback may further promote the recovery of upper limb function in patients with hemiplegia after stroke based on task-oriented training.
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Objective To investigate the effects of mirror visual feedback (MVF) and electromyographic biofeedback (EMGBF) on up-per extremity function in hemiplegic patients after stroke based on task-oriented training. Methods 90 patients with hempiplegia after stroke were randomly divided into control group (n=30), EMGBF group (n=30) and MVF group (n=30). All patients accepted routine rehabilitation and task-oriented training once a day for 8 weeks. The EMGBF group also accepted EMGBF, and the MVF group accepted MVF in addi-tion. They were assessed with Fugl-Meyer Assessment (FMA) and the Upper Extremity Function Test (UEFT), and their integrated electro-myogram (iEMG) of affected upper extremities were recorded before and after treatment. Results All the groups improved in scores of FMA and UEFT, as well as the iEMG after treatment (P<0.05), and ranked as the MVF group, the EMGBF group and the control group from im-proving more to less (P<0.05). Conclusion Mirror visual feedback combined with electromyographic biofeedback may further promote the recovery of upper limb function in patients with hemiplegia after stroke based on task-oriented training.
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Objective To study the immediate effect of applying a portable functional electrical stimulation device (PUEFESD) to the upper extremities of stroke patients.Methods Twenty stroke survivors were selected.Pairs of electrodes of the PUEFESD were applied on the dorsal and palm sides of the affected forearm and thenar to stimulate the extensors and flexors as well as the thenar muscles sequentially according to a programmed protocol.Functional evaluation was conducted before and immediately after the stimulation.All participants were assessed with regard to their motor function and performance in the activities of daily living using an upper extremity function test (UEFT),the upper extremity motor function portion of the Fugal-Meyer assessment (FMA),and rating with the modified Barthel index (MBI).A visual analogue scale (VAS) was used to evaluate pain in the affected upper extremity.Results The patients' average FMA score was 19.4 ± 7.1 before the stimulation and 30.4 ± 9.6 after.The corresponding UEFT scores were 3.6 ± 3.7 and 26.9 ± 5.9,and the average MBI scores were 53.8 ± 26.2 and 65.8 ± 17.7.All of these increases were statistically significant.The average VAS score,however,did not change significantly.Conclusions Functional electric stimulation can quickly improve upper extremity function and the ADL ability of stroke patients,but pain is not relieved significantly.
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Objective To observe the effect of core stability training combined with eye acupuncture on motor function in patients with hemiplegia after stroke.Methods Eighty patients with hemiplegia after stroke were randomly divided into a treatment group and a control group (40 cases in each).Both groups were given regular rehabilitation training, but the patients in the treatment group also were taught core stability training of their waist and abdominal muscle groups, their shoulder muscles, trunk and pelvis.They were also given eye acupuncture.A trunk control test (TCT) , Berg's balance scale (BBS), the modified Barthel index (MBI), functional ambulation categories (FACs) and the Fugl Meyer assessment scale (FMA) were used to assess motor function before and after treatment.Results At the end of 6 weeks of treatment, all of the measurements in both groups had significantly improved.The average TCT, BBS, MBI, FMA, and FAC scores of the treatment group significantly exceeded those of the control group.Conclusions Core stability training and eye acupuncture together can significantly improve the motor function of hemiplegic stroke survivors.The combination therapy is worthy of clinical popularization and application.
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PURPOSE: The purpose of this study was to identify the effects of auricular acupressure therapy on the upper extremity function, perceived health status and Activities of Daily Living for rehabilitation among stroke patients at home. METHODS: As a quasi-experimental study, non-equivalent control group pretest-posttest design was used. Data were collected from August 1st to September 31st, 2012. Participants were 28 (Experimental 17, Control 11) stroke patients at home. Using the SPSS/WIN 12.0 program, data were analysed by the chi2-test, Fisher's exact test, Mann-Whitney U test and Wilcoxon signed rank test. RESULTS: Upper extremity function (U=28.00, p=.001) and activities of daily living (U=47.50, p=.029) were significantly higher in the experimental group compared to the control group. However, perceived health status was not significantly different between the two group. CONCLUSION: This study proved that auricular acupressure therapy was effective for upper extremity function and activities of daily living among stroke patients at home.