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.

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.

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.

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.