ABSTRACT
This preliminary randomized clinical trial explores the efficacy of task-oriented electromyography (EMG)-triggered multichannel functional electrical stimulation (EMG-MES) compared to single-channel cyclic neuromuscular electrical stimulation (cNMES) on regaining control of voluntary movements (CVM) and the ability to execute arm-hand-activities in subacute stroke patients with moderate arm paresis. Twelve ischemic stroke patients (Fugl-Meyer Assessment Arm Section (FMA-AS) score: 19-47) with comparable demographics were block-randomized to receive 15 sessions of cNMES or EMG-MES over three weeks additionally to a conventional neurorehabilitation program including task-oriented arm training. FMA-AS, Box-and-Block Test (BBT), and Stroke-Impact-Scale (SIS) were recorded at baseline and follow-up. All participants demonstrated significant improvement in FMA-AS and BBT. Participants treated with EMG-MES had a higher mean gain in FMA-AS than those treated with cNMES. In the SIS daily activities domain, both groups improved non-significantly; participants in the EMG-MES group had higher improvement in arm-hand use and stroke recovery. EMG-MES treatment demonstrated a higher gain of CVM and self-reported daily activities, arm-hand use, and stroke recovery compared to cNMES treatment of the wrist only. The protocol of this proof-of-concept study seems robust enough to be used in a larger trial to confirm these preliminary findings.
ABSTRACT
BACKGROUND: Neurorehabilitation requires the development of severity-dependent and successful therapies for arm/hand rehabilitation in stroke patients. OBJECTIVE: To evaluate the effectiveness of adding mirror therapy to bilateral EMG-triggered multi-channel electrostimulation for the treatment of severe arm/hand paresis in stroke patients. METHODS: The subjects of this randomized, controlled, multicentre study were stroke patients who had suffered their first insult between 1 and 6 months before study start and had severe or very severe arm/hand paresis, as classified by Fugl-Meyer-Assessment. Subjects were randomly allocated to an intervention group (nâ=â16) or control group (nâ=â17). Both groups were treated for 3 weeks (5x week, 30 minutes) with bilateral EMG-triggered multi-channel electrostimulation. The intervention group additionally received mirror feedback of the unaffected limb. The primary outcome measure was motor recovery of the upper extremities, as measured by the Fugl-Meyer Assessment. RESULTS: The Intervention Group with very severe paresis had significantly better motor recovery in total Fugl-Meyer Assessment (pâ=â0.017) at a medium effect size (Cohen) of dâ=â0.7, due to a significant recovery of shoulder and elbow function (pâ=â0.003) in the Fugl-Meyer Assessment Part A subtest. For subjects with severe paresis, additional mirror therapy did not significantly influence outcome. CONCLUSION: Additional mirror therapy in combination with EMG-triggered multi-channel electrostimulation is therapeutically beneficial for post-acute stroke patients with very severe arm/hand paresis.
Subject(s)
Electric Stimulation Therapy/methods , Electromyography/methods , Feedback, Sensory/physiology , Outcome Assessment, Health Care , Paresis/therapy , Stroke Rehabilitation/methods , Stroke/therapy , Upper Extremity/physiopathology , Aged , Female , Humans , Male , Middle Aged , Paresis/etiology , Severity of Illness Index , Stroke/complicationsABSTRACT
Este estudo discute os resultados e conclusoes quanto a algumas provas Piagetianas, realizadas com trinta criancas, de uma escola publica municipal, situada em vila de baixo nivel socio-economico no Municipio de Canoas. Estas criancas frequentarao a primeira serie em 1984, sendo que uma parte delas frequentou a pre-escola e a outro nao. As estruturas operatorias investigadas neste estudo foram: classificacao aditiva e inclusao em classes, correspondencia serial e conservacao da substancia. A partir do levantamento e analise dos dados, conclui-se que praticamente todas as criancas avaliadas nao apresentam as estruturas operatorias desenvolvidas para que possam iniciar-se na apresendizagem da matematica na primeira serie. Alem disso, constatou-se um resultado contrario ao esperado, pois observamos que as criancas que nao cursaram a pre-escola apresentam as estruturas operatorias um pouco mais desenvolvidas que as criancas que fizeram o pre. Tendo-se em vista estas conclusoes, levanta-se alguns questionamento sobre os objetivos da pre-escola e da primeira serie quanto ao desenvolvimento cognitivo e global da crianca, sugerindo-se alternativas metodologicas ao processor, baseadas na Teoria de Piaget.
