Effects of cognitive exercise therapy on upper extremity function in stroke patients – A case study

Joanna Pawełczyk, Katarzyna Adamczewska, Jacek Lewandowski

J. Pawełczyk, K. Adamczewska, J. Lewandowski – Effects of cognitive exercise therapy on upper extremity function in stroke patients – A case study. FP 2017; 17(4); 70-75

Abstract

Purpose. The purpose of this study was to evaluate the effects of cognitive exercise therapy on upper extremity function in a female stroke patient.
Materials and methods. The study was conducted on a 76-year-old female patient who suffered an ischemic stroke and exhibited severe left-sided hemiparesis. The patient underwent a 6-week therapy regimen based on the cognitive exercise treatment method, with 3 therapy session each week. Therapy progress was evaluated every two weeks using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES).
Results. The patient showed motor function improvement on all MESUPES subscales. The overall progress was 31%. The highest rate of improvement (45%) was recorded on the first part of the scale (MESUPES I), which evaluated general movements. In the second part, the patient showed a 25% improvement in joint mobility and a 17% improvement in coordination.
Conclusion. The cognitive exercise therapy proved to be an effective treatment for improving upper extremity function of the patient.

Key words:
neurorehabilitation, stroke, Perfetti method, cognitive exercise therapy

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Hemiplegic shoulder pain – clinical factors and pain pressure sensitivity

Agnieszka Sobierajska-Rek

A. Sobierajska-Rek – Hemiplegic shoulder pain – clinical factors and pain pressure sensitivity. FP 2017; 17(4); 24-32

Abstract

Shoulder pain is a typical symptom accompanying upper extremity paresis or plegia after stroke.
Aim of the study. The aim of this study was to determine relationship among clinical factors, such as subluxation or impingement syndrome, spasticity, pain pressure sensitivity and incidence of shoulder pain in stroke patients.
Material and methods. Stroke survivors with hemiplegic shoulder pain (n = 26), and the controls without shoulder pain (n = 11) underwent pain pressure threshold measure at biceps and supraspinatus, soft tissues in shoulder region, motor function of upper limb in Brunnstrom scale and spasticity were assessed.
Results. There was no difference in sensitivity in supraspinatus, but the correlation at the level of statistical tendency is present in biceps. Spasticity was more severe in the shoulder pain group, and intensity of pain was correlated with an increase in muscle tonus.
Conclusion. There is correlation between the pain in hemiplegic shoulder and symptoms of impingement syndrome and subluxation in shoulder joint. The tendency to increased pain pressure sensitivity was observed in biceps in the group with shoulder pain.

Key words:
stroke, hemiplegia, shoulder pain

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Analysis of the effect of comprehensive rehabilitation with stabilometric platform on body balance in patients with multiple sclerosis and after stroke

Justyna Redlicka, Jan Niedzielski, Elzbieta Miller

J. Redlicka, J. Niedzielski, E. Miller – Analysis of the effect of comprehensive rehabilitation with stabilometric platform on body balance in patients with multiple sclerosis and after stroke. FP 2017; 17(4); 18-23

Abstract

Objective. The objective was to evaluate the effect of a comprehensive rehabilitation program on body balance in patients with multiple sclerosis (MS) and after cerebral stroke.
Materials and methods. Tests were performed at the NeurorehabilitationWard of Dr K.Jonscher Municipal Hospital no. 3 in Lodz on randomly selected patients with MS and after stroke. The group included 50 subjects – 30 men and 20 women, aged 32 to 76 years. All the patients were examined twice for body balance with the use of a computerized stabilometric platform. The following parameters were analyzed: the mean number of all sways, the mean number of sways forwards and backwards, as well as to the left and right. All the sway parameters were measured both with eyes closed and open. The results obtained after rehabilitation were compared to those from before the introduction of rehabilitation.
Results. A course of comprehensive rehabilitation of MS patients resulted in a significant reduction of sways with eyes closed (p < 0.001), however less significant with eyes open (p < 0.2). Similarly, a marked improvement was observed in post-stroke patients in the mean number of sways with eyes closed (p < 0.001), whereas with eyes open, the results were not statistically significant (p < 0.02). Conclusions. Comprehensive rehabilitation has a significant effect on the body balance of patients with MS and after stroke. In the trial with the use of a stabilometric platform, better results after a course of rehabilitation were noted inpost-stroke patients. Key words: stabilometric platform, balance, stroke, multiple sclerosis

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The assessment of primary rehabilitation effects for patients with brain stroke and the evading effect

Marek Woszczak, Katarzyna Bogacz, Katarzyna Syrewicz, Magdalena Józefowicz-Korczyńska, Jan Szczegielniak

M. Woszczak, K. Bogacz, K. Syrewicz, M. Józefowicz-Korczyńska, J. Szczegielniak – The assessment of primary rehabilitation effects for patients with brain stroke and the evading effect. FP 2017; 17(3); 16-27

Abstract

Purpose. The purpose of this study was to assess the prevalence of hemispatial neglect in stroke patients and to determine whether this condition can affect the results of early rehabilitation and hospitalization duration.
Materials and methods. 63 randomly selected stroke patients were examined. The participants were divided into two groups: group A – participants without hemispatial neglect; and group B – participants diagnosed with hemispatial neglect. Physical functionality of participants, assessed at admission to the rehabilitation ward and at discharge, was compared. The results were organized into tables and graphs. The collected data were analyzed with the chi-square test of goodness of fit.
Results. The results show an increase in physical functionality of all participants. Participants without hemispatial neglect have considerably improved in their functional independence, needing little help with most activities assessed as part of the study. On the other hand, participants diagnosed with hemispatial neglect showed much less improvement, despite the same amount of therapy, and remained on a lower mobility level. Hence, hemispatial neglect affected their hospitalization duration.
Conclusion. Participants with hemispatial neglect exhibited slower functional recovery. Hemispatial neglect affects hospitalization duration (R=0.0082).

Key words:
Stroke, hemispatial neglect, early rehabilitation

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Balance Versus Postural Stability and Its Disorders in Patients after Ischemic Stroke – Theoretical Study

Magdalena Goliwąs, Ewa Kamińska, Marta Flis-Masłowska,
Marzena Wiernicka, Jacek Lewandowski

M. Goliwąs, E. Kamińska, M. Flis-Masłowska, M. Wiernicka, J. Lewandowski – Balance Versus Postural Stability and Its Disorders in Patients after Ischemic Stroke – Theoretical Study. FP 2017; 17(1); 38-44

Abstract
The aim of this study is to explain the differences between balance and postural stability, and the changes which occur in these traits in patients after stroke.
Human being has the natural ability to stand on two feet and to move on the two feet across an unfamiliar terrain. However these abilities do constitute a big challenge for the balance control system, which is being controlled through the three separate systems, two of which are sight, responsible for planning of the locomotion activity, vestibular system, responsible for spatial orientation of the human body. The third, and the most complex is the sensory system (composed of proprioceptors and mechanoreceptors). In terms of biomechanics the balance is defined as the ability to maintain the center of gravity of the human body above the supporting plane.
One of the most important determinants of the correct body posture is the postural stability, which wider concept and denotes the ability to recover the balance. This is possible thanks to three strategies. Patients after a stroke have a problem with the ability of spontaneous kinesthetic response. The distribution of pressure forces of the plantar side of a foot on the ground changes, it becomes difficult to maintain balance, and the consequences are frequent falls, femur fractures and problems with the basic activities of daily living.

Key words:
Postural stability, balance, stroke

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The rehabilitation of patients after the cerebral stroke including socio-demographic factors

Marzena Kobylańska, Bartosz M. Wójcik, Renata Szczepaniak, Zbigniew Śliwiński

M. Kobylańska, B. M. Wójcik, R. Szczepaniak, Z. Śliwiński – The rehabilitation of patients after the cerebral stroke including socio-demographic factors. FP 2016;16(4);82-97

Abstract

Introduction. According to the World Health Organization, cerebral stroke constitutes the third largest cause of death just after heart disease and cancer. It is estimated that every year 4.6 million people die due to stroke, including 3.2 in developing countries and 1.2 in developed ones. It has been observed that the effectiveness of physiotherapy in patients after a stroke depends on biological factors but also on their socio-economic condition.
The dissertation goal. The goal of this dissertation is to analyze the role of socio-demographic factors in the process of physiotherapy for patients after a cerebral stroke.
Materials and methods. The research has been carried out at the neurological rehabilitation ward of the Wrocław Center for Rehabilitation and Sports Medicine. The research group consisted of 120 patients after cerebral stroke. The examination was conducted at two time intervals – on the first day of the patient’s treatment at the neurological rehabilitation ward, and after three weeks of rehabilitation. All the patients participated in the systematic physiotherapy, which is a standard procedure at the neurological rehabilitation ward, where they had a defined schedule of frequency and time of rehab. A full research cycle lasted for three weeks for every patient. The following methods were used in the research: Barthel Scale (Barthel Index, BI), Lawton Scale (Instrumental Activity of Daily Living (IADL), Rivermead Mobility Index (RMI), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Generalized Self – Efficacy Scale (GSES), Acceptance of Illness Scale (AIS), and Visual Analogue Scale (VAS).
Results. Factors regarding the biological nature of the patient’s condition such as age, time since the stroke, type of stroke, and number of coexisting diseases have a definite impact on the low effectiveness of the physiotherapy conducted at the neurological rehabilitation ward. Socio-demographic factors, marital status, professional activity, and kind of job, also have an impact on the low effectiveness of the conducted physiotherapy.
Conclusions. Comprehensive rehabilitation of neurological patients after the cerebral stroke, taking into account socio-demographic factors is essential to achieve high effectiveness of physiotherapy.

Keywords:

stroke, physiotherapy, socio-demographic factors

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Stroke as a civilisation-scale problem – physical treatment analysis

Ewelina Czerczak, Włodzisław Kuliński

E. Czerczak, W. Kuliński – Stroke as a civilisation-scale problem – physical treatment analysis. FP 2016;16(1);24-35

Abstract
Introduction. Stroke is one of the most common forms of damage to the central nervous system. In Poland, approximately 60,000 people suffer from stroke every year. Disorders resulting from stroke require the implementation of long-term care and rehabilitation. The main objective of physiotherapy is to restore patient independence in daily living and improve the quality of life of the patient. Aim of study. The aim of the study was to evaluate the effect of physiotherapy on the functional status and quality of life of patients after stroke. Material and Methods. The study comprised 30 patients after stroke (24 patients after ischemic stroke and 6 patients after hemorrhagic stroke) staying at the neurological rehabilitation ward in the St. Luke Specialist Hospital in Końskie. During 8 weeks of hospitalization, the patients underwent intensive rehabilitation. They were examined twice, namely on admission and on the day of discharge. The examination included completing a questionnaire assessing the quality of life on a scale of 1 to 10 points, an assessment of the functional status using the Barthel Index and an assessment of muscle spasticity of the upper and lower limb with the modified Ashworth scale. The results of functional status assessment were compared according to the type of stroke, time from stroke to rehabilitation and the number of concomitant diseases. Moreover, the effect of the comprehensive rehabilitation on the assessment of independence in daily living was studied after treatment, as was the influence of rehabilitation on the degree of spasticity and the use of orthopedic aids. Results and Conclusion. The functional status improved in all patients. Better final results were obtained in patients after ischemic stroke and suffering from fewer comorbidities. The results were better in those whose rehabilitation commenced earlier. The quality of life was significantly higher than before rehabilitation. The degree of spasticity was significantly reduced and the use of orthopaedic aids was improved.

Key words:
stroke, treatment, physiotherapy

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Body Weight Supported Treadmill Training with Parestand system as walking therapy of patients early after stroke: a pilot study

Beata Stach, Marcin Błaszcz, Aleksandra Bober, Mariola E. Wodzińska, Joanna Zyznawska

B. Stach, M. Błaszcz, A. Bober, M. E. Wodzińska, J. Zyznawska – Body Weight Supported Treadmill Training with Parestand system as walking therapy of patients early after stroke: a pilot study. FP 2016;16(2);54-63

Abstract

Background. Body Weight Supported Treadmill Training (BWSTT) is high intensive and task-specific gait therapy for stroke patients. Effectiveness of BWSTT is repeatedly proven, however superiority of that training over overground walking is often contested. It is rarely practised and investigated method in Poland.
Patients and Methods. 20 patients in the early post-stroke rehabilitation phase able to walk. All patient participated in traditional physiotherapy based on Bobath and PNF concepts. Experimental group (10 people) additionally received Body Weight Supported Treadmill Training. Control group (10 people) additionally received overground walking. Baseline and postintervention assessments included Berg Balance Scale, Timed Up & Go, 10 m Time Walking Test and 6 Minute Walk Test.
Results. Both groups showed statistically significant improvement in all outcome measures (P<0,05). Group BWSTT increased distance by 108,4±75,7 m and control grouop by 57±51,3 m in 6 Minute Walk Test. Difference between the groups was not statistically significant (p=0,28). Group BWSTT shortened time in Timed Up & Go by 9±1,4 seconds and control group by 2,7±1,1 seconds. Difference between the groups was not statistically significant (p=0,63). Group BWSTT improved by 7,0±3,7 points, and control group by 6,6±4,4 points in Berg Balance Scale. Difference between the groups was not statistically significant (p=0,88). Group BWSTT increased gait velocity by 0,25±0,13 m/s, and control group by 0,28±0,13 m/s. Difference between the groups was not statistically significant (p=0,96). Conclusions. Either Body Weight Supported Treadmill Training or overground walking could improve balance, reduce risk of falls, increase endurance and velocity of gait in walking subacute stroke patients. BWSTT could have tendency to more effective increasing gait endurance. Key words: stroke, hemiparesis, physiotherapy, rehabilitation, gait

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