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Kiper P1, Baba A1, Maistrello L1, Rossi S1, Agostini M1, Turolla A1
1Fondazione Ospedale San Camillo IRCCS, Laboratory of Neurorehabilitation Technologies, Venice, Italy
Background: The proprioceptive-based training (PBT) is a neuromodulatory treatment modality evolved from bilateral training, and is based on motor learning principles such as tasks repetition with concurrent use of feedback. This treatment modality aims to foster the voluntary muscle contraction and to render the motor system more susceptible to future functional recovery. In the present study authors hypothesized that the simultaneous stimulation of both afferent and efferent pathways could be essential to foster voluntary muscle contraction in post-stroke patients with upper limb hemiplegia.
Purpose: To evaluate the effect of PBT for fast recovery of voluntary muscle contraction in the sub-acute phase after stroke.
Methods: Patients affected by stroke within 6 months before enrolment and with complete paresis were randomized in two groups. Both treatments lasted 1h/day, 5 days/week for 15 sessions. The pre- and post- assessment comprised the surface Electromyography (sEMG), Medical Research Council scale (MRC) and Dynamometer (primary outcomes). Biceps brachii, triceps brachii, carpi flexors, carpi extensors, digitorum flexors and digitorum extensors were taken into consideration. The Fugl-Meyer upper extremity scale (F-M UE), modified Ashworth scale and Functional Independence Measure scale (FIM) were used as secondary outcome measures. The PBT consisted of multidirectional exercises executed synchronously with unaffected limb and verbal feedback. Patients were asked to move both limbs with the same frequency performing bilateral flexion-extension of one of the upper limb districts. The movement execution of the affected arm was supported by the physiotherapist coherently with the patient's movement initialization. The movement of unaffected limb was considered as the reference movement which was synchronized with the passive one. In the CT group patients were treated in accordance with the post-stroke guidelines based on tailored individual exercises, and in accordance with patient's functional status.
Results: Thirty-four patients with mean time of 3.03±1.99 months since stroke (24 ischemic and 10 hemorrhagic; 17 female and 17 male) were enrolled in the study and randomized to PBT (n=24) and CT (n=10) group.
Statistically significant improvement was observed within PBT group for: sEMG biceps p=0.001, sEMG triceps p=0.002, MRC overall p=0.001, Dynamometer overall p=0.001; F-M UE p=0.001; FIM p=0.001. As well as within CT group for: MRC overall p=0.021, Dynamometer overall p=0.022, Ashworth p=0.040).
The comparison between groups showed significant difference for; sEMG triceps (p=0.039), MRC overall (p=0.001), Dynamometer overall (p=0.001) and F-M UE (p=0.014).
Conclusion(s): Findings of this study revealed that PBT may be a feasible intervention to improve motricity of upper limb in stroke survivors. Results showed that PBT may induce a recovery of voluntary muscle contraction in sub-acute phase after stroke and can provide a background for future complex rehabilitation.
Implications: PBT might have a favorable approach for motor recovery. It appear to be a feasible and effective form of intervention for post-stroke motricity improvement in the early post-acute phase.
Keywords: Stroke, Proprioceptive training, Neurorehabilitation
Funding acknowledgements: Funded by the statutory resources of the Institute.
Purpose: To evaluate the effect of PBT for fast recovery of voluntary muscle contraction in the sub-acute phase after stroke.
Methods: Patients affected by stroke within 6 months before enrolment and with complete paresis were randomized in two groups. Both treatments lasted 1h/day, 5 days/week for 15 sessions. The pre- and post- assessment comprised the surface Electromyography (sEMG), Medical Research Council scale (MRC) and Dynamometer (primary outcomes). Biceps brachii, triceps brachii, carpi flexors, carpi extensors, digitorum flexors and digitorum extensors were taken into consideration. The Fugl-Meyer upper extremity scale (F-M UE), modified Ashworth scale and Functional Independence Measure scale (FIM) were used as secondary outcome measures. The PBT consisted of multidirectional exercises executed synchronously with unaffected limb and verbal feedback. Patients were asked to move both limbs with the same frequency performing bilateral flexion-extension of one of the upper limb districts. The movement execution of the affected arm was supported by the physiotherapist coherently with the patient's movement initialization. The movement of unaffected limb was considered as the reference movement which was synchronized with the passive one. In the CT group patients were treated in accordance with the post-stroke guidelines based on tailored individual exercises, and in accordance with patient's functional status.
Results: Thirty-four patients with mean time of 3.03±1.99 months since stroke (24 ischemic and 10 hemorrhagic; 17 female and 17 male) were enrolled in the study and randomized to PBT (n=24) and CT (n=10) group.
Statistically significant improvement was observed within PBT group for: sEMG biceps p=0.001, sEMG triceps p=0.002, MRC overall p=0.001, Dynamometer overall p=0.001; F-M UE p=0.001; FIM p=0.001. As well as within CT group for: MRC overall p=0.021, Dynamometer overall p=0.022, Ashworth p=0.040).
The comparison between groups showed significant difference for; sEMG triceps (p=0.039), MRC overall (p=0.001), Dynamometer overall (p=0.001) and F-M UE (p=0.014).
Conclusion(s): Findings of this study revealed that PBT may be a feasible intervention to improve motricity of upper limb in stroke survivors. Results showed that PBT may induce a recovery of voluntary muscle contraction in sub-acute phase after stroke and can provide a background for future complex rehabilitation.
Implications: PBT might have a favorable approach for motor recovery. It appear to be a feasible and effective form of intervention for post-stroke motricity improvement in the early post-acute phase.
Keywords: Stroke, Proprioceptive training, Neurorehabilitation
Funding acknowledgements: Funded by the statutory resources of the Institute.
Topic: Neurology: stroke; Disability & rehabilitation
Ethics approval required: Yes
Institution: Fondazione Ospedale San Camillo IRCCS
Ethics committee: Approved by Ethical committee of the IRCCS San Camillo Hospital
Ethics number: Protocollo 2012.07 BAT v.1.2
All authors, affiliations and abstracts have been published as submitted.
