Citations
To investigate the sleep state of mild stroke patients and relationship between sleep disturbance and functional status.
A total of 80 acute stroke patients were enrolled in this study. The criteria for inclusion in the study was as following: 1) first stroke, 2) cognitive function preserved enough to perform the test (Mini Mental State Examination ≥24), 3) good functional levels (Modified Rankin Scale ≤3), 4) upper extremity motor function preserved enough to perform occupational tests (hand strength test, Purdue pegboard test, 9-hole peg test, and Medical Research Council score ≥3), and 5) less than 2 weeks between the stroke and the assessment. Quality of sleep was assessed by using Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Activities of daily living was assessed by using the Modified Barthel Index (MBI) and depressed mood was assessed by using the Beck Depression Inventory (BDI). Gross and fine motor function of the upper extremity was assessed by using hand strength test (Jamar dynamometer), Purdue pegboard test, and the 9-hole peg test.
The results of the occupational assessment were fine in the good sleepers. The PSQI, ESS, and ISI were correlated with some of the assessment tools (BDI, MBI, Purdue pegboard, 9-hole peg, and hand strength).
In conclusion, this study emphasizes that sleep disturbance can affect the functional status in mild acute stroke patients. Therefore, clinicians must consider sleep status in stroke patients and need to work to control it.
Citations
To evaluate motor excitability and hand function on the non-dominant side according to the polarity of transcranial direct current stimulation (tDCS) on the motor cortex in a healthy person.
tDCS was applied to the hand motor cortex for 15 minutes at an intensity of 1 mA in 28 healthy right-handed adults. Subjects were divided randomly into four groups: an anodal tDCS of the non-dominant hemisphere group, a cathodal tDCS of the non-dominant hemisphere group, an anodal tDCS of the dominant hemisphere group, and a sham group. We measured the motor evoked potential (MEP) in the abductor pollicis brevis and Jabsen-Taylor hand function test (JTT) in the non-dominant hand prior to and following tDCS. All study procedures were done under double-blind design.
There was a significant increase in the MEP amplitude and a significant improvement in the JTT in the non-dominant hand following anodal tDCS of the non-dominant hemisphere (p<0.05). But there was no change in JTT and a significant decrease in the MEP amplitude in the non-dominant hand following cathodal tDCS on the non-dominant hemisphere and anodal tDCS of the dominant hemisphere.
Non-dominant hand function is improved by increased excitability of the motor cortex. Although motor cortex excitability is decreased in a healthy person, non-dominant hand function is maintained. A homeostatic mechanism in the brain might therefore be involved in preserving this function. Further studies are warranted to examine brain functions to clarify this mechanism.
Citations
Method: Forty two chronic stroke patients were enrolled and classified into two groups, experimental and control group. The experimental group took CIT for 2 weeks. CIT consisted of restraint of the unaffected upper extremity with massive training of the affected upper extremity. The motor function of patient's upper extremity was assessed by Manual Function Test (MFT) and Jebsen Hand Function Test before treatment, at 2 weeks and at 8 weeks after the treatment.
Results: The withdrawal rate was 46.7% during CIT period. There was substantial significant improvements in MFT and Jebsen Hand Function Test after 2 weeks of treatment in the experimental group (p＜0.05). The effects in the experimental group were maintained at 6 weeks after cessation of the treatment.
Conclusion: CIT is considered to be an effective treatment for motor function of the chronic hemiplegic upper extremity motor function, and will be useful as an additional therapeutic tool. (J Korean Acad Rehab Med 2003; 27: 813-818)
Objective: To evaluate the efficacy of botulinum toxin type A in the treatment of spasticitc and dystonic upper limbs in a group of cerebral palsy children
Method: Eighteen children with cerebral palsy who did not have fixed contractures in the wrist and hand were enrolled (mean age 9.0 years; range 6∼15). Measurements were obtained before and at 1 and 3 months after botulinum toxin A injections. Assessments included spasticity (modified Ashworth scale), range of motion of thumb and functional assessments including Melbourne assessment of unilateral upper limb function and Jebsen Taylor hand function test. Hand and forearm muscles were injected with 1∼3 u/kg botulinum toxin.
Results: Spasticity measured by modified Ashworth scale decreased by 1 month and diminished spasticity continued for 3 months. Range of motion of thumb increased by 1 and 3 months. In Jebsen hand function test, patients showed functional improvements in item 6 (lifting light weight object) and item 7 (lifting heavy object). Melbourne assessment of unilateral upper limb function scores improved from a mean value of 92 at baseline to a mean value of 101 at 1 month and a mean value of 105 at 3 months.
Conclusion: Botulinum toxin A would be helpful in some selected cerebral palsy patients with upper limb dysfunction. But further research including randomized controlled study is needed on the use of botulinum toxin A to improve function.
Objective: The objective of this study is to determine the effect of unilateral brain lesion on hand strength and dexterity of ipsilateral side in hemiplegic patients and the change of strength and dexterity of ipsilateral hand after rehabilitation according to the side of brain lesion.
Method: Sixty four hemiplegic patients with unilateral brain lesion underwent hand function tests for the ipsilateral hand to the brain lesion. Grip strength, tip pinch, lateral pinch, and palmar pinch strength were measured, and Purdue pegboard test was performed. Results were compared with a group of forty age-matched healthy volunteers.
Results: There was significant decrement of hand strength and dexterity of ipsilateral side except grip strength in patients with unilateral brain lesion in the begining of rehabilitation compared with the controls. Hand strength and dexterity of ipsilateral hand was significantly improved after rehabilitation. There was no significant difference in hand strength and dexterity of ipsilateral side according to the side of hemispheric lesion.
Conclusion: Ipsilateral upper extremity function in hemiplegic patients may also be affected adversely, and therefore rehabilitation treatment for ipsilateral upper extremity function should be involved.
Objective: To determine the usefulness of Jebsen hand function test in rheumatoid arthritis patients
Method: The experimental subjects were divided into 3 groups (Group 1：17 persons; control, Group 2：21 persons; RA without hand deformity, Group 3：16 persons; RA with hand deformity). They were assessed by Jebsen hand function test. Further included assessments were grip and pinch strength, joint deformity counts, and visual analogue scales.
Results: Jebsen hand function test scores were significantly decreased in rheumatoid arthritis patients compared with control. Jebsen hand function test scores were well correlated with visual analogue scales in group 2 and correlated with joint deformity counts in group 3.
Conclusions: Jebsen hand function test would be useful tool for the evaluation of hand function in the rheumatoid arthritis patients with hand deformity.
Objective: The purpose of this study is to evaluate the effects of intramuscular botulinum toxin A injection for the improvement of hand function in spastic hemiplegia.
Method: We have studied 8 patients with spastic hemiplegia. Botulinum toxin A was injected into target muscles with electromyographic guidance. Before injection, muscle activity patterns were evaluated by dynamic electromyography. Follow-up assessments were performed at three months after injection.
Results: There were continuous activity patterns in all dynamic electromyography of target muscles. Dynamic electromyography of antagonist muscles in five patients showed normal phasic activity pattern but it showed absent pattern in other three patients. Mean modified Ashworth scale decreased significantly after injection. There were an improvement in functional classification and a significant increase of mean scores of unilateral hand skills after injection in patients with normal phasic pattern of antagonist muscles.
Conclusion: Botulinum toxin A can improve the impaired hand movement and function in spastic hemiplegia by reducing spasticity and contracture of the target muscles in cases of normal phasic activity in antagonist muscles and continuous activity in target muscles.
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