Investigation of the effect of task-oriented occupational therapy on daily living activity performance in chronic stroke patients.

Objective: Task-oriented therapy (TOT) is used to increase the effectiveness of upper extremity (UE) in activity daily living (ADL). This study aimed to investigate the effect of TOT on the participation and ADLs of stroke patients. Methods: Between October 2018 and February 2019, 28 chronic stroke patients were included in the study treated in Kocaeli University Hospital, Department of Physical Medicine and Rehabilitation, Turkey. The performance areas and participation status of the patients in which they experienced limitations were evaluated with the Canadian Occupational Performance Scale (COPM), and their level of independence in ADLs was evaluated with the Modified Frenchay Activity Index (mFAI) and Barthel Index (BI). All patients were included in the occupational therapy (OT) program five days a week for three weeks at Kocaeli University Hospital. Three ADLs in which they had difficulties were studied with 28 patients. Each of the activities was designed specifically for the patient. All assessments were repeated after three weeks of treatment. Results: A total of 28 patients, 12 females and 16 males, diagnosed with stroke, were included in the study. A statistically significant increase was found in the COPM performance and satisfaction value compared to the pre-treatment value (p<0.001). A statistically significant difference was found between pre- and post-treatment mFAI and BI values (p<0.001). Conclusions: Adding task-oriented therapy to the rehabilitation programs of stroke patients will contribute to the improvement of ADL.

The efficiency of mirror therapy in peripheral nerve injuries.

Objectives: The purpose of this study was to investigate the effectiveness of mirror therapy on pain, sensory, and functional development in addition to conventional rehabilitation and occupational practices in patients with a peripheral nerve injury in the hand. Patients and methods: Twenty-six patients with peripheral nerve injury in the hand were included in this randomized controlled study between November 2017 and May 2018. The patients were randomly assigned to the mirror group (n=14) and the control (n=12) group. Both groups received conventional therapy in our clinic for 45 min a day during weekdays for six consecutive weeks. The mirror group received an additional 10-15 min of visual mirror therapy. Visual Analog Scale (VAS), Duruöz Hand Index, Quick Disabilities of the Arm, Shoulder, and Hand, Jebsen hand function test, and Semmes-Weinstein monofilament test were used for the assessment of pain, hand function, and sensation of the patients at baseline and after treatment. The handgrip strength of the patients was measured with a dynamometer. Results: A total of 20 patients (17 males, 3 females; mean age 31.9±16.5, range 16 to 65 years) completed the study, with 10 in each group. Statistically significant improvement was detected in hand skill functions, such as page-turning (p=0.004), backgammon packing (p=0.023), and heavy object lifting (p=0.029) in the mirror group. A statistically significant decrease was found in total scores of VAS after treatment in both groups (p<0.05). Conclusion: The results imply that mirror therapy integrated with conventional rehabilitation may aid additional benefits on hand functions in peripheral nerve injury. These results demonstrate that mirror therapy can be used in addition to the rehabilitation program of patients with peripheral nerve injury.

Development of GO Move: A Website for Children With Unilateral Cerebral Palsy.

It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.

Development of Go Move: A Website for Children With Unilateral Cerebral PalsyTherapists and parents of children with unilateral cerebral palsy were interviewed to understand their experience of home programs and gain input for creating a mobile website with information on goal setting and implementing home programs. The interviews provided valuable information about the functionality, features, content, and naming of the website. GO Move, a mobile website aimed to provide information on goal setting, activity selection, and tracking of exercises and activities in the home environment for children with unilateral cerebral palsy, was developed based on the information from the interviews.

Investigation of the Relationship between Sensory-Processing Skills and Motor Functions in Children with Cerebral Palsy.

The main purpose of this study is to examine the relationship between sensory-processing skills and gross motor functions, bimanual motor functions, and balance in children with cerebral palsy (CP). A total of 47 patients between the ages of 3 and 10, diagnosed with CP, who received or applied for treatment in our physical therapy and rehabilitation unit were included in the study. Sensory profiling (SP), assisting hand assessment (AHA), the Gross Motor Function Measure-66 (GMFM-66), and the Pediatric Berg Balance Scale (PBBS) were used in the evaluation of the children with CP who participated in the study. The Gross Motor Function Classification System (GMFCS) was used to classify the children based on functional abilities and limitations, and the Manual Ability Classification System (MACS) was used to classify the children based on manual dexterity. The SP parameters were compared with AHA, GMFM-66, and PBBS results, and with GMFCS and MACS levels. Statistically significant relationships were found between AHA and SP, PBBS, and SP and between GMFM-66 and SP (p < 0.05). Our study shows that there are some disorders in sensory processing in children with CP. We think that sensory evaluations should be included in the CP rehabilitation program.

Goal Attainment after Treatment with Abobotulinumtoxina and a Tailored Home Therapy Programme in Children with Upper Limb Spasticity: Descriptive, Exploratory Analysis of a Large Randomized, Controlled Study

OBJECTIVE: This exploratory analysis of a large, randomized, double-blind study (NCT02106351) describes the effect of treatment with abobotulinumtoxinA followed by a tailored home exercises therapy programme in enabling children with upper limb spasticity due to cerebral palsy to achieve their functional goals using goal attainment scaling (GAS). METHODS: Children with cerebral palsy and spasticity in ≥ 1 upper limb received up to 4 injection cycles of abobotulinumtoxinA (2 U/kg (cycle 1 only), 8U/kg and 16U/kg) into the elbow and wrist flexors and other upper limb muscles selected to support individual treatment goals. Children followed a home exercises therapy programme, which included stretches and exercises specifically chosen to facilitate goal achievement and engagement in activities. RESULTS: For cycle 1, most children had active function goals set as their primary goal (69.7% vs 19.2% passive function goals). GAS T- scores and goal responder rates at week 16 indicated that most types of primary goal were achieved at least as expected during cycle 1 (all groups). Primary goal GAS T-scores were generally maintained for the first 3 abobotulinumtoxinA treatment cycles. CONCLUSION: Most children with upper limb spasticity treated with repeat cycles of abobotulinumtoxinA supported by an individualized home exercises therapy programme achieved their functional goals.

The Effect of Whole Body Vibration Treatment on Upper Extremity Functions Compromised by Stroke.

INTRODUCTION: In patients with neurological disorders Whole Body Vibration (WBV) has been reported to improve motor function. Our aim was to assess the effects of WBV on upper extremity function in adult stroke patients. METHODS: Forty-three post-stroke patients were randomly assigned to two groups: treatment group and control group. The demographic characteristics and Modified Ashworth Scale (MAS) were recorded in all patients. The plegic upper extremity range of motions (ROM) and motor functions were evaluated by goniometric measurement and Jebsen-Taylor Hand Function Test (JTHFT). All patients participated in a conventional rehabilitation program for three weeks while the treatment group also received WBV over the same period. All evaluations were performed before and after therapy. RESULTS: The median (range) age of all patients was 51.0±13.7 (18-66) years. The groups numbered 26 and 17 patients for the treatment and control groups respectively. No significant differences were found between the two groups in the pre-treatment evaluation based on the JTHFT all scores (p>0.05). Significant improvement was found in the elbow extension ROM degree (p=0.019) for the treatment group. A statistically significant improvement was observed in all parameters of JTHFT in the treatment group after the intervention, whereas only page turning, removing small objects, removing large light objects and removing large heavy objects showed a statistically significant improvement in controls (p<0.05). CONCLUSION: Statistically significant differences were observed between the treatment and control groups after intervention. WBV treatment is effective for the improvement of ROM and upper extremity functions in stroke patients.

The Effect of Whole Body Vibration Treatment on Balance and Gait in Patients with Stroke.

INTRODUCTION: In patients with neurological disorders Whole Body Vibration (WBV) has been reported to improve motor function. Our aim was to assess the effects of WBV on both balance and walking performance in adult stroke patients. METHODS: Forty three post-stroke patients were randomly divided into two groups. One would receive WBV therapy (WBV group) while the control group would not. All patients participated in a conventional rehabilitation program for three weeks while the vibration group also received WBV over the same period. Patients balance and walking performance were evaluated using the Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and computerized gait analysis. All evaluations were performed before and after therapy. RESULTS: The median (range) age of all patients was 51.00 (18-66) years. The groups numbered 26 and 17 patients for the WBV and control groups respectively. After intervention, significant improvements were found in the WBV group for BBS score (p=0.004), TUG score (p=0.035), step length (p=0.004) and walking speed (p=0.031) when compared to the controls. CONCLUSION: WBV is effective for the improvement of balance and gait performance in stroke patients.

Development of a Pediatric Goal-Centered Upper Limb Spasticity Home Exercise Therapy Program for Use in a Phase-III Trial of Abobotulinumtoxina (Dysport®).

AIMS: To create a standardized home exercise therapy program that could be implemented by international sites to provide a consistent level of therapeutic intervention for pediatric patients participating in an ongoing Phase-III, randomized, controlled trial of repeat abobotulinumtoxinA injections for pediatric upper limb spasticity (NCT02106351). METHODS: Physical therapists, occupational therapists, and medical doctors worked collaboratively to design an exercise therapy program to be implemented in the home setting. In this article, we describe the development process and the finalized program that is currently being used in the Phase-III trial. RESULTS: The final program is presented as a "toolbox" for therapists, and includes a standardized step-wise process for choosing the most appropriate exercises and functional activities to achieve the agreed treatment goals of each abobotulinumtoxinA injection. The core toolbox includes: a clear protocol for clinicians, information sheets, signature of commitment forms, exercise score charts, and the library of exercises and functional activities that therapists choose from to aid the patient in achieving their treatment goals. CONCLUSIONS: Implementation of this home therapy program provides a standardized background of good practice against which to test the efficacy of abobotulinumtoxinA. Preliminary data show that the program is readily accepted by patients and their families.