Effect of Scapular Kinesiotaping as an Adjunct to Dynamic Neuromuscular Stabilization Exercises on Upper Extremity Functions in Stroke Patients

Background and Purpose: Stroke is one of the leading causes of death and disability in India. Upper extremities get more affected in Middle cerebral artery syndrome. Stroke patients have lack of functional ability of upper extremity due to scapular malalignment resulting from paralysis of the scapular muscles. Kinesiotape helps to realign the muscles and thus it becomes easy to activate or inhibit them. We hypothesised that Dynamic Neuromuscular Stabilisation exercises along with kinesiotape could improve upper extremity function. Methodology: Ethical clearance was obtained. Informed consent was taken. 30 patients were selected according to inclusion and exclusion criteria. 15 subjects were randomly divided into experimental and control group. Subjects were given Dynamic neuromuscular stabilisation exercises for scapular strengthening. The experimental group was given Kinesiotaping to the scapula using muscle technique. Pre and post treatment assessment was done using Upper Extremity Function Index, grip strength and scapular abduction position with MB ruler. Result: The intergroup comparison revealed a highly significant difference for upper extremity function index and grip strength whereas scapular abduction was not significant. Conclusion: The Scapular Kinesiotaping as an adjunct to Dynamic Neuromuscular Stabilization Exercises is significantly effective to improve upper extremity functions and grip strength in post stroke patients. Key words: Stroke, Upper Extremity Functions, Dynamic Neuromuscular Stabilization Exercises, Scapular Kinesiotaping.

Effect of Transcranial Direct Current Stimulation Combined with Rehabilitation on Arm and Hand Function in Stroke Patients: A Systematic Review and Meta-Analysis

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that may enhance motor recovery after stroke. We performed a systematic review and meta-analysis to assess the efficacy of tDCS combined with rehabilitation on arm and hand function after stroke. Electronic databases were searched from their inception to September 2021. We performed a systematic review of selected randomized controlled trials, and methodological qualities were measured using the PEDro (Physiotherapy Evidence Database) scale. We calculated the standardized mean difference for effect size using the Comprehensive Meta-Analysis 3.0 software. We selected 28 studies for the systematic review and 20 studies for the meta-analysis. The overall effect size was 0.480 (95% CI [0.307; 0.653], p < 0.05), indicating a moderate effect size of tDCS combined with rehabilitation for upper extremity function in stroke survivors. The tDCS with occupational therapy/physical therapy (0.696; 95% CI [0.390; 1.003], p < 0.05) or virtual reality therapy (0.510; 95% CI [0.111; 0.909], p < 0.05) was also significantly more effective than other treatments. This meta-analysis of 20 randomized controlled trials provides further evidence that tDCS combined with rehabilitation, especially occupational therapy/physical therapy and virtual reality therapy, may benefit upper extremity function of the paretic upper limb in stroke patients.

Examining the effects of upper extremity function and arm sling type on balance, gait and fall risk in patients with hemiparesis

Background/aims Previous studies have reported conflicting results on the effects of arm slings on the balance and gait of patients with hemiparesis. These previous studies did not consider the ability to control the upper extremity on the affected side as a factor that could affect the patient's balance or gait when an arm sling was applied. Hence, the aim of this study was to investigate the effect of upper extremity function in the affected side and arm position according to the sling type on balance, gait and fall. Methods A total of 31 stroke patients participated in the study and were assigned to two groups according to upper extremity function (low-score group and high-score group). Under three conditions (no sling, forearm sling and shoulder sling), a fall risk test, postural stability test and limits of stability test were performed and speed, stride duration, step length and total time were measured. Results When the high-score group wore forearm slings, the static and dynamic balance ability decreased and the fall risk increased. When the low-score group wore forearm slings and shoulder slings, the static and dynamic balance ability increased and the fall risk decreased. The high-score group had a shorter gait time when wearing shoulder slings. When the low-score group wore forearm slings, the speed and step length increased and the total time decreased, enhancing the overall gait ability. Conclusions For stroke patients with better upper extremity control ability, shoulder slings are more appropriate. For patients with poor upper extremity control ability, forearm slings are more appropriate. Using the appropriate sling according to the upper extremity function can improve balance and gait ability and fall risk can be reduced.

Feasibility of Using a Commercial Board Game to Assess Upper Extremity Function in Older Adults

Upper extremity function, particularly the hand, declines with aging and is predictive of executive ability and independence. Standard assessments typically focus on strength partly due to a lack of easily administered functional tasks requiring multi-joint coordination and precision grasp. This study aimed to determine the feasibility of using an inexpensive board game to assess upper extremity function in older adults. Six healthy older adults (77 +/- 5.1 years) completed reaching tasks using the Connect4® game that requires grasping and placing small discs into a vertical board. Tasks included different hand configurations (unilateral, bilateral), and two dual-task conditions (serial subtraction by 7s and placing colored discs to match specific color patterns). The time to complete each task was recorded. For comparison purposes, participants completed a standardized pegboard test (Purdue Pegboard) using one or both hands. Connect4 results were similar to age-normative findings reported for the Purdue Pegboard. Dominant versus non-dominant hand performance did not differ while bilateral coordination tasks were slower than unilateral tasks for both the Purdue Pegboard (p&lt;0.05) and Connect4 (p&lt;0.01). Pegboard and Connect4 times were moderately to strongly correlated for all hand configurations. Dual-task conditions using Connect4 led to longer completion times (p&lt;0.05). Preliminary results support the use of Connect4 as a functional upper extremity assessment tool for older adults. It is inexpensive, engaging, easy to use, and allows for cognitive-motor assessment using dual-task protocols, a critical factor in maintaining functional independence in older individuals. Further research will include a formal validation study across a wider age range.

Relationship between Trunk Impairment and Upper Extremity Function, and Its Impact on Activities of Daily Living in Chronic Stroke Survivors

Background: Stroke often leads to significant impairment of trunk and upper extremity functions, which is associated with decreased quality of life and functional performance in all domains. Trunk stability and control is considered to be a prerequisite for upper extremity function in stroke survivors. Therefore, it is important to evaluate the relationship between trunk impairment and upper extremity function in stroke survivors which may help in improving their ADL’s by giving proper treatment. Methods: 20 chronic stroke survivors with age group between 40 – 80 years were included in this study. Trunk impairment, upper extremity function and activities of daily living of all the participants were determined using trunk impairment scale, Chedoke arm and hand activity inventory scale (version 8) and functional independence measure – motor scoring scale. Results: Using Karl Pearson’s Correlation coefficient, moderate positive correlation was observed between TIS and CAHAI-8. Strong positive correlation was noted between TIS and FIM-M, whereas, moderate positive correlation was noted between CAHAI-8 and FIM-M which was found to be highly statistically significant. Conclusion: Our study concludes that, a moderate positive correlation exists between trunk impairment and upper extremity function in chronic stroke survivors. The study also reveals that, both trunk impairment and upper extremity function has strong and moderate correlation on their activities of daily living. Keywords: Stroke, trunk function, paretic arm, functional performance, stroke rehabilitation.