Factors influencing recovery of upper limb motor function during constraint-induced movement therapy for people with stroke.

Objective: The aim of this study is to determine the personal and clinical factors that can predict recovery of motor function in people with stroke. Methods: Characteristics of the study participants such as age, sex, time since stroke and type of stroke, motor function, shoulder pain, amount and quality of use of the affected limb in the real world, wrist and elbow spasticity, handedness, central post-stroke pain and dose of massed practice were recorded. The data obtained were analyzed using descriptive statistics and multiple regression. Results: A total of 144 patients with stroke with mean age, 58.71 ± 19.90 years participated in the study. The result showed that, the whole model significantly explained the total variance by 88.4%, F(14, 144) = 32.870, R 2 = 0. 0.781, p < 0.001. However, in the final model, only four independent variables in the order of degree of predictability, amount of use of the limb in the real world (Beta = 0.455, p = 0.003), intensity of practice during rehabilitation session (Beta = 0.321, p < 0.001), wrist spasticity (Beta = 0.148, p = 0.004) and side affected (Beta = 0.093, p = 0.033) significantly predicted recovery of motor function. Conclusion: Encouraging the use of the limb in the real world may be more important than practice during rehabilitation session in the clinic or in the laboratory.

Vagus nerve stimulation for the treatment of epilepsy: things to note on the protocols, the effects and the mechanisms of action.

Epilepsy is a chronic brain disorder that is characterized by repetitive un-triggered seizures that occur severally within 24 h or more. Non-pharmacological methods for the management of epilepsy were discussed. The non-pharmacological methods include the vagus nerve stimulation (VNS) which is subdivided into invasive and non-invasive techniques. For the non-invasive techniques, the auricular VNS, stimulation of the cervical branch of vagus nerve in the neck, manual massage of the neck, and respiratory vagal nerve stimulation were discussed. Similarly, the stimulation parameters used and the mechanisms of actions through which VNS improves seizures were also discussed. Use of VNS to reduce seizure frequency has come a long way. However, considering the cost and side effects of the invasive method, non-invasive techniques should be given a renewed attention. In particular, respiratory vagal nerve stimulation should be considered. In doing this, the patients should for instance carry out slow-deep breathing exercise 6 to 8 times every 3 h during the waking hours. Slow-deep breathing can be carried out by the patients on their own; therefore this can serve as a form of self-management.HIGHLIGHTSEpilepsy can interfere with the patients' ability to carry out their daily activities and ultimately affect their quality of life.Medications are used to manage epilepsy; but they often have their serious side effects.Vagus nerve stimulation (VNS) is gaining ground especially in the management of refractory epilepsy.The VNS is administered through either the invasive or the non-invasive methodsThe invasive method of VNS like the medication has potential side effects, and can be costly.The non-invasive method includes auricular VNS, stimulation of the neck muscles and skin and respiratory vagal nerve stimulation via slow-deep breathing exercises.The respiratory vagal nerve stimulation via slow-deep breathing exercises seems easy to administer even by the patients themselves.Consequently, it is our opinion that patients with epilepsy be made to carry out slow-deep breathing exercise 6-8 times every 3 h during the waking hours.

Predictors of high dose of massed practice following stroke.

Objective: The aim of this study is to determine the factors that affect patients' ability to carry out high dose of massed practice. Methods: Patients with stroke were included in the study if they had no severe impairment in motor and cognitive functions. Dose of massed practice, motor function, perceived amount and quality of use of the arm in the real world, wrist and elbow flexors spasticity, dominant hand stroke, presence of shoulder pain, and central post-stroke pain were assessed on the first day. Dose of massed practice was assessed again on the second day. The data were analyzed using descriptive statistics and linear multiple regression. Results: Only motor function (ß = -0.310, r = 0.787, P < 0.001), perceived amount of use (ß = 0.300, r = 0.823; 95% CI = 0.34-107.224, P = 0.049), severity of shoulder pain (ß = -0.155, r = -0.472, P = 0.019), wrist flexors spasticity (ß = -0.154, r = -0.421, P = 0.002), age (ß = -0.129, r = -0.366, P = 0.018), dominant hand stroke (ß = -0.091, r = -0.075, P = 0.041), and sex (ß = -0.090, r = -0.161, P = 0.036) significantly influenced patients' ability to carry out high dose of massed practice. Conclusion: Many factors affect patients' ability to carry out high dose of massed practice. Understanding these factors can help in designing appropriate rehabilitation.

Quality of life of stroke survivors: A cross-sectional study of association with functional independence, self-reported fatigue and exercise self-efficacy.

OBJECTIVES: Stroke is a leading cause of disability and one of the most debilitating conditions especially in the developing world. Rehabilitation focuses on improving functional ability which may enhance quality of life (QoL). The aims of this study were to investigate the association between QoL and each of functional independence (FI), self-reported fatigue (SRF) and exercise self-efficacy (ESE) in stroke survivors. METHODS: This is a descriptive cross-sectional survey, documenting QoL, FI, SRF and ESE of stroke survivors seen at the physiotherapy outpatient clinics of two health care facilities in Oyo state, Nigeria. Descriptive and inferential statistics were used to analyse the data with significance level set at 0.05. RESULTS: Participants were 110 stroke survivors (64 males; 46 females) aged 60.9 ± 11.9 years. Significant associations were found between QoL and each of FI and ESE (p < 0.01) while no significant association was observed for SRF. FI strongly predicts good QoL in stroke survivors (OR = 16.34; p < 0.01) and high ESE is a determinant of QoL (OR = 6.46; p = 0.04). Stroke survivors with SRF were less likely to report good QoL. DISCUSSION: Functional independence and exercise self-efficacy were directly associated with QoL and were also major predictors of good QoL in stroke survivors.

Predictors of gross motor function and activities of daily living in children with cerebral palsy.

To determine the influence of selected impairment variables, spasticity, trunk control, upper limb function and selective motor control of the lower limb on gross motor function and activities of daily living in children with cerebral palsy (CP). Seventy children with CP, 40 boys and 30 girls, with age range between 11 and 156 months were recruited in this cross-sectional study. Data on spasticity, selective motor control of the lower limb, upper limb function and trunk control were assessed using modified Ashworth scale (MAS), selective motor control of the lower limb (SCALE), paediatric arm function test, trunk motor control assessment and GMFM88, respectively. Among all the variables assessed, only trunk control significantly predicted gross motor function (beta = 0.880; P < 0.001) and activities of daily living (beta = 0.550; P < 0.05). However, gross motor function and activities of daily living have significant (P < 0.05) negative correlations with spasticity, and positive correlations with selective motor control of the lower limb and trunk control. Trunk control is the most influencing factor on gross motor function and activities of daily living in children with CP. Therefore, achieving trunk control especially in those at GMFCS levels V and VI should be a priority during the rehabilitation of children with CP.

Assessment of family needs of children with cerebral palsy in Northern-Nigeria: A cross-sectional study.

PURPOSE: This study aimed to identify the needs and priorities of parents of children with cerebral palsy (CP) in order to improve care by increasing family participation in rehabilitation programmes. METHODS: This cross-sectional questionnaire-based study was conducted between January to March 2019. Convenience sampling was used to recruit 43 family members (18 years and above) of children with CP who came to the physiotherapy departments for rehabilitation services for their children. Fisher's exact test was used to analyse the association between socio-demographic characteristics and each of the need items. RESULTS: Five different items were identified to be the family needs that were most frequently met: a) 'need for active involvement in the child's treatment and therapies' (n= 40; 93.0%), b) 'need for the provision of standard medical care (n= 39; 90.7%), c) 'need for questions to be answered honestly' (n= 38; 88.4%), d) 'need for healthcare professionals to respect the child's wishes' (n= 36; 83.7%), e) 'need for mothers to discuss their feelings (depression, stress etc.) with someone who has similar experience' (n= 36; 83.7%). Conversely, three items were the most unmet family needs: a) 'need to have professionals to consult whenever the child needs help' (n= 39; 90.7%), b) 'need to be informed about the child's prognosis' (n= 41; 95.3%), and c) 'need to have financial support to provide the child with adequate care' (n= 43; 100%). CONCLUSION: All participants overwhelmingly reported that their financial needs were their highest priority. The multiple needs of families of children with disabilities must be assessed and considered in rehabilitation services when treating children with CP.

Prevalence, pattern and impact of sleep disturbance on quality of life and exercise participation among children with cerebral palsy in Kano city.

INTRODUCTION: Sleep disturbance (SD) could have negative impact on the general well-being of children with cerebral palsy (CWCP). OBJECTIVES: The purpose of this study was to assess the prevalence of SD and its impact on quality of life and exercise participation among CWCP. MATERIAL AND METHODS: In the cross-sectional study, CWCP and their siblings were recruited from secondary and tertiary hospitals in Kano City. SD, gross motor function (GMF), spasticity and quality of life were assessed with SD scale, GMF classification system, modified Ashworth scale and pediatric quality of life inventory, respectively. Data was analyzed with Mann-Whitney U and chi-square tests, linear and hierarchical regressions using SPSS version 20.0. RESULTS: There were 200 CWCP (aged 4.35±8.03 years) and 200 siblings (aged 5.89±3.06 years). The prevalence of SD in CWCP was 31.5%. CWCP suffered more SD than their siblings (p<0.001). SD in CWCP is influenced by GMF level (ß=0.378, p<0.001) and gender (ß=0.16, p<0.05). SD has negative influence on quality of life (ß=-0.18, p<0.001), active participation in home-based (ß=-0.23, p<0.000), and clinic-based exercises (ß=-0.24, p<0.00). GMF levels (ß=-0.505, p<0.0001), hamstring spasticity (ß=-0.250, p<0.005), and age (ß=-0.207, p<0.001) also have influenced on quality of life. CONCLUSION: One-third of the CWCP suffered pathologic SD, which has negative impact on their quality of life and the ability to actively participate in both home and clinic-based exercises. Aside SD, other factors such as child's age, spasticity level and severity of motor impairment also affected their quality of life negatively. Enhancing the motor abilities of CWCP may improve their quality of sleep and quality of life.

Perceived social support and social constraints in Hausa women stroke survivors: A cross-sectional study.

Background: Social factors modulating stroke outcomes are found to be culturally and gender inclined. We examined social support and social constraints in Hausa women stroke survivors.Aim: To determine social support and social constraints in Hausa women after stroke.Materials and methods: Seventy-four (74) Hausa women stroke survivors were conveniently recruited from three tertiary health centers to participate in this cross-sectional study. Sociodemographic and stroke-related attributes of the participants were obtained. Perceived social support and social constraints were assessed using multidimentional scale of perceived social support (MSPSS) and the social problem questionnaire (SPQ), respectively. The relationship and association between different variables were assessed using Pearson's correlation and chi-square test, respectively.Results: Majority of the participants (60.8%) reported adequate level of social support. Similarly, most participants reported fairly low level of social constraints in total family stress (91.9%) and nonchild-related stress (90.5%). None of the participants' sociodemographic features had a significant relationship with either social support or social constraints (p > .05). Findings indicated an inverse relationship between social support and social constraint.Conclusion: Findings of this study suggest that adequate social support potentially limits the level of social constraint encountered by women who suffered stroke. The Hausa culture seems to be impressive in characteristically demonstrating high level of social support as found in this study. It is recommended that physiotherapist should assist by providing educative programs that would increase caregiver's knowledge of social support and how to develop it and cultural values that emphasize positive social interaction should be encouraged.

Comparative Efficacy of Soft Tissue Massage and Transcutaneous Electric Nerve Stimulation in the Management of Hemiplegic Shoulder Pain.

BACKGROUND: Hemiplegic Shoulder pain (HSP) is a common clinical consequence of focal cerebral insult. The study investigated the comparative efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) and Soft Tissue Massage (STM) in the management HSP. METHOD: A total of 50 consenting stroke patients with HSP completed the 8 weeks pretest posttest quasi-experimental study. They were assigned into either TENS or STM groups using simple random sampling. Both TENS and STM treatments were administered on subscapularis, supraspinatus and posterior deltoid muscles for 16 sessions. HSP was evaluated pre and post intervention with visual analog scale. Within and between group differences in HSP were compared using paired and unpaired t-tests respectively with SPSS version 16.0 with probability level of 0.05 to indicate level of significance. RESULTS: The age of patients in the TENS and STM groups was 56±9.26years and 57±7.51years respectively. Duration of stroke was 10±6 months and 9±4 months for TENS and STM groups respectively. There was no significant between group differences in HSP at baseline (TENS=4.76±2.17; STM=5.48±2.06; p>0.05). Within group comparison of HSP scores pre and post intervention in the TENS group indicated a significant reduction (P<0.05); also the same applies to STM group (P<0.05). When the post treatment HPS scores were compared across the groups, there was a significant difference in favor of TENS group (TENS=1.48±0.51; STM=2.12±1.17; p<0.05). CONCLUSION: Both TENS and STM contribute to the modulation of HSP in stroke patients and both could become handy in augmenting other forms of management. However TENS is more effective.

Analysis of Direct Monthly Cost of Outpatient Hospital-Based Care for Children With Cerebral Palsy in Kano, Nigeria.

BACKGROUND: Children with cerebral palsy require effective, accessible and affordable medical and rehabilitation care. OBJECTIVE: The aim of this study was to evaluate the direct monthly cost of outpatient hospital-based care for children with cerebral palsy (CP) in Kano City, Nigeria. METHODS: The study was a cross-sectional survey. Consenting participants were recruited using the purposive sampling technique. Data on cost of medical and physiotherapy consultations, number of consultations per month, cost of diagnostic investigations, and out-of-pocket expenditures were captured using a researcher-designed questionnaire. Data were analyzed with descriptive statistics using Microsoft Excel and SPSS version 20. RESULTS: A total of 106 children with CP and their caregivers participated in this study. The mean age of the children was 3.18 ± 1.90 years and that of their caregivers was 27.32 ± 4.63 years. The average direct cost of outpatient care per month was ₦14 295.38 (Nigerian naira) ($46.87) ± ₦13 211.52 ($43.32). The average monthly cost of physiotherapy was ₦503.77 ($1.65) ± ₦220.79 ($0.72), whereas those for transportation and radiological investigations were ₦1861.49 ($6.10) ± ₦1435.06 ($4.71) and ₦3771.46 ($12.37) ± ₦5135.32 ($16.84), respectively. CONCLUSION: The average direct monthly cost of providing outpatient hospital-based care for children with CP in Kano City, Nigeria may not be affordable because most of the participants earned very meager monthly incomes. The highest medical cost was incurred from radiological investigation, whereas transportation was the most important out-of-pocket cost. The Nigerian government should make a policy decision for the automatic enrollment of all children diagnosed with CP into the National Health Insurance Scheme.

Investigating post-stroke fatigue: An individual participant data meta-analysis.

OBJECTIVE: The prevalence of post-stroke fatigue differs widely across studies, and reasons for such divergence are unclear. We aimed to collate individual data on post-stroke fatigue from multiple studies to facilitate high-powered meta-analysis, thus increasing our understanding of this complex phenomenon. METHODS: We conducted an Individual Participant Data (IPD) meta-analysis on post-stroke fatigue and its associated factors. The starting point was our 2016 systematic review and meta-analysis of post-stroke fatigue prevalence, which included 24 studies that used the Fatigue Severity Scale (FSS). Study authors were asked to provide anonymised raw data on the following pre-identified variables: (i) FSS score, (ii) age, (iii) sex, (iv) time post-stroke, (v) depressive symptoms, (vi) stroke severity, (vii) disability, and (viii) stroke type. Linear regression analyses with FSS total score as the dependent variable, clustered by study, were conducted. RESULTS: We obtained data from 14 of the 24 studies, and 12 datasets were suitable for IPD meta-analysis (total n = 2102). Higher levels of fatigue were independently associated with female sex (coeff. = 2.13, 95% CI 0.44-3.82, p = 0.023), depressive symptoms (coeff. = 7.90, 95% CI 1.76-14.04, p = 0.021), longer time since stroke (coeff. = 10.38, 95% CI 4.35-16.41, p = 0.007) and greater disability (coeff. = 4.16, 95% CI 1.52-6.81, p = 0.010). While there was no linear association between fatigue and age, a cubic relationship was identified (p < 0.001), with fatigue peaks in mid-life and the oldest old. CONCLUSION: Use of IPD meta-analysis gave us the power to identify novel factors associated with fatigue, such as longer time since stroke, as well as a non-linear relationship with age.

Variation in Functional Independence among Stroke Survivors Having Fatigue and Depression.

Objective. This study evaluated variation in functional independence in activities of daily living (ADL) and instrumental activities of daily living (IADL) among individuals with poststroke fatigue (PSF) and poststroke depression (PSD). Methods. A cross-sectional survey involved 65 consenting poststroke survivors who were purposively recruited from physiotherapy clinics of the University College Hospital, Ibadan, Adeoyo Maternity Teaching Hospital, Ibadan, and Federal Medical Center, Gusau. Participants were assessed for symptoms of PSD with short geriatric depression scale-15, PSF with fatigue severity scale, ADL with Barthel Index and IADL with Nottingham extended ADL scale. Data analysis was done using Chi-square and unpaired t-test with significance level being 0.05. Results. Participants' age ranged from 58 to 80 years. PSD alone (P = 0.002) and both PSF and PSD (P = 0.02) were significantly associated with ADL, while PSF alone was not (P = 0.233). PSD alone (P = 0.001) and both PSF and PSD (P = 0.001) significantly negatively affected IADL, while PSF alone had no significant effect (P = 0.2). Conclusions. Participants with PSD alone and those with both PSF and PSD had lower functional independence in ADL and IADL.