Benefits of a repetitive facilitative exercise program for the upper paretic extremity after subacute stroke: a randomized controlled trial.

BACKGROUND: Repetitive facilitative exercise (RFE), a combination of high repetition rate and neurofacilitation, is a recently developed approach to the rehabilitation of stroke-related limb impairment. Preliminary investigations have been encouraging, but a randomized controlled evaluation has yet to be performed. OBJECTIVES: To compare the efficacy of RFE with that of conventional rehabilitation in adults with subacute stroke. METHODS: A total of 52 adults with stroke-related upper-limb impairment (Brunnstrom stage ≥III) of 3 to 13 weeks' duration participated in this randomized, controlled, observer-blinded trial. Participants were randomized into 2 groups and received treatment on a 4-week, 40 min/d, 5 d/wk schedule. Those assigned to RFE received 100 standardized movements of at least 5 joints of their affected upper extremity, whereas those in the control group participated in a conventional upper-extremity rehabilitation program. Primary and secondary outcomes (improvement in group action research arm test [ARAT] and Fugl-Meyer Arm [FMA] scores, respectively) were assessed at the end of training. RESULTS: In all, 49 participants (26 receiving RFE) completed the trial. ARAT and FMA scores at baseline were 19 ± 21 and 39 ± 21 (mean ± standard deviation). Evaluation at the trial's completion revealed significantly larger improvements in the RFE group than in the control group in both ARAT (F = 7.52; P = .009) and FMA (F = 5.98; P = .019) scores. CONCLUSIONS: These findings suggest that RFE may be more effective than conventional rehabilitation in lessening impairment and improving upper-limb motor function during the subacute phase of stroke.

Effects of 5 minutes of neck-muscle vibration immediately before occupational therapy on unilateral spatial neglect.

PURPOSE: To evaluate the effects of neck-muscle vibration for 5 min before occupational therapy (OT) on unilateral spatial neglect (USN). METHOD: In this multiple-baseline design study for 6 weeks (A(1)-B-A(2) design: A(1), A(2); conventional OT without neck-muscle vibration, B; neck-muscle vibration before OT together with conventional OT), we examined 11 right brain-damaged patients in the post-acute phase of stroke who showed USN. Sessions A(1) and A(2): conventional OT for 40 min once daily for 5 days a week. Session B: the left posterior neck muscles of the patient were subjected to vibration for 5 min, without confirming the appearance of a kinaesthetic illusion, immediately before OT, and then the same OT programme as in sessions A(1) and A(2) was performed. Each session lasted 2 weeks. USN and activities of daily living (ADL) were evaluated at 2-week intervals by the Behavioural Inattention Test (BIT) and Functional Independence Measure (FIM), respectively. RESULTS: Significant increases in the total scores in both the conventional subtest and behavioural subtest of the BIT were only seen during session B. FIM scores increased significantly during both sessions A(1) and B. CONCLUSIONS: The application of neck-muscle vibration before OT may have positive effects on USN, but the specific effect on the improvement of ADL is not clear.

Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand.

OBJECTIVE: To study the effects on the hemiplegic upper limb of repetitive facilitation exercises (RFEs) using a novel facilitation technique, in which the patient's intention to move the hemiplegic upper limb or finger was followed by realization of the movement using multiple sensory stimulations. METHODS: Twenty-three stroke patients were enrolled in a cross-over study in which 2-week RFE sessions (100 repetitions each of five-to-eight types of facilitation exercise per day) were alternated with 2-week conventional rehabilitation (CR) sessions, for a total of four sessions. Treatments were begun with the 2-week RFE session in one group and the 2-week CR session in the second group. RESULTS: After the first 2-week RFE session, both groups showed improvements in the Brunnstrom stages of the upper limb and the hand, in contrast to the small improvements observed during the first CR session. The Simple Test for Evaluating Hand Function (STEF) score, which evaluates the ability of manipulating objects, in both groups improved during both sessions. After the second 2-week RFE and CR sessions, both groups showed little further improvement except in the STEF score. CONCLUSION: The novel RFEs promoted the functional recovery of the hemiplegic upper limb and hand to a greater extent than the CR sessions.