A study of dynamic hand orthosis combined with unilateral task-oriented training in subacute stroke: A functional near-infrared spectroscopy case series.

Background: Motor dysfunction in the upper extremities after stroke prohibits people with stroke from being independent in daily living. The application of fNIRS to explore brain activity under rehabilitation intervention is a research focus on neurorehabilitation. Objective: The purpose of this study was to explore, using a grip-release ring motor task, the activated changes of regions of interest and changes in motor function utilizing fNIRS technology and test scales on persons with stroke who received unilateral task-oriented therapy with a hand orthosis in the early subacute stroke period before and after intervention. The study aimed to find a sensitive motor task and region of interest first, then to evaluate the feasibility and mechanism of this rehabilitation method by utilizing fNIRS technology in the next randomized controlled trial. Methods: In this case series, eight right-handed, right hemiplegia subacute stroke persons (6 males,2 females from age 47 to 72) were enrolled. They received 30 min of unilateral task-oriented therapy without orthosis and 30 min of unilateral task-oriented therapy with orthosis (5 days/week) for 4 weeks. Activated channel numbers and beta values based on oxygenated hemoglobin concentration change using a grip-release ring motor task were estimated with fNIRS. Clinical outcome measures, including grip strength evaluation, action research arm test, and Fugl-Meyer assessment of the arm, were evaluated at the same time. Results: Individual activation analysis showed that, after intervention, Subjects 1, 2, 6, 7, and 8 had the maximum mean beta value located in the left premotor cortex, while Subjects 4 and 5 had the maximum mean beta value located in the left sensorimotor cortex. The activation analysis of Subject 3 showed the maximum mean beta value located in the right premotor cortex. Deactivations of left sensorimotor cortex, left premotor cortex, and bilateral prefrontal cortex were observed after intervention which were different from other cases. Group activation analysis showed that bilateral cerebral hemispheres were activated in all eight participants, with right hemisphere and right supplementary motor cortex activated dominantly. After the intervention, the activation of bilateral hemispheres decreased but in different brain regions; there was a trend that the activation intensity of left sensorimotor cortex, right premotor cortex, and right prefrontal cortex decreased while activation intensity of left premotor cortex and left prefrontal cortex increased. Each participant demonstrated improvements in all the clinical test scales after intervention. Conclusions: Left premotor cortex, left sensorimotor cortex, and right supplementary motor cortex may be the primary regions of interest. Grasp-release ring task was not appropriate to achieve our fNIRS research objective and a more sensitive motor task or more sensitive evaluating indicator should be used in further studies.

Study on the relationship between 25-hydroxyvitamin D level and rehabilitation of stroke patients.

AIM OF THE STUDY: To analyse the relationship between 25-hydroxyvitamin D (25(OH)D) level and rehabilitation in stroke patients. MATERIAL AND METHODS: 100 stroke patients hospitalized in the Neurorehabilitation Department of China Rehabilitation Research Center from November 2019 to April 2020 were selected as the research subjects. And set up a case group. 50 subjects who underwent outpatient physical examination in China Rehabilitation Research Center in the same period were selected as the control group. The differences of biochemical and bone metabolism indexes such as serum 25(OH)D, blood lipid, liver and kidney function between the two groups were analysed. We took rehabilitation efficacy as the dependent variable, Pearson correlation analysis and multivariate logistic regression analysis were performed to analyse the indicators affecting rehabilitation efficacy. RESULTS: The average level of 25(OH)D in the case group was significantly lower than that in the control group ( p < 0.05). The rehabilitation efficacy was significantly positively correlated with 25(OH)D level ( p < 0.003) and significantly negatively correlated with duration of disease ( p < 0.01) and NIHSS score ( p < 0.05). CONCLUSIONS: The increase in 25(OH)D is a protective factor for non-occurrence of cerebral infarction, and the increase in the 25(OH)D level is conducive to the prognosis of cerebral infarction.

Upper Limb Training with a Dynamic Hand Orthosis in Early Subacute Stroke: A Pilot Randomized Trial.

OBJECTIVES: To investigate the effect of the addition of a dynamic hand orthosis to unilateral task-oriented training in early subacute stroke. DESIGN: Pilot randomized trial with concealed allocation, measurer blinding, and intention-to-treat analysis. SETTING: Rehabilitation hospital. PARTICIPANTS: Thirty subacute stroke patients with moderate-to-severe upper limb disability. INTERVENTION: All participants received 4 weeks (60 min per day, 5 days a week) of unilateral task-oriented training. The experimental group (n = 15) wore a dynamic hand orthosis during half of the training time (i.e. 30 min per day). OUTCOME MEASURES: Primary outcome was the upper limb activity measured using the Action Research Arm Test (ARAT) measured at baseline and 4 weeks. Secondary outcomes were the Nine-hole Peg Test, Fugl-Meyer Assessment for upper extremity, grip strength, modified Ashworth Scale, Barthel Index and EuroQol-5D. RESULTS: No difference between groups was found for the primary outcome ARAT (mean difference 4/57, 95% confidence interval (95% CI) -5 to 13) nor for any secondary outcome. CONCLUSION: No additional benefit was found of wearing a dynamic hand orthosis during unilateral taskoriented training in the early subacute period.

Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients.

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.