Active- Passive Bilateral Therapy as a Priming Mechanism for Individuals in the Subacute Phase of Post- Stroke Recovery. A Feasibility Study. Department of Occupational Therapy (ME), Rush University; Department of Physical Medicine and Rehabilitation (JS), Feinberg School of Medicine, Northwestern University; and Sensorimotor Performance Program (JS), Rehabilitation Institute of Chicago, Chicago, Illinois. All correspondence and requests for reprints should be addressed to Mary Ellen Stoykov, Ph. D, MS, OTR/L, Department of Occupational Therapy, Rush University, 6. South Paulina Street, Suite 1. Chicago, IL 6. 06. See other articles in PMC that cite the published article. Abstract. Objective. To assess the feasibility of treating inpatient stroke survivors with active- passive bilateral therapy as a motor priming technique before occupational therapy. Design. Single case series with two matched pairs in the subacute post- stroke rehabilitation phase. The test patients received active- passive bilateral therapy plus upper limb motor training. Control patients received only the motor training. Learn the difference between hemiplegia vs hemiparesis after stroke and how to treat both of these side effects. Results. Both Fugl- Meyer Upper Extremity scores and Action Research Arm Test scores improved in this small group of test and control patients. The magnitude of improvement was greater in test patients who received active- passive bilateral therapy plus unilateral training. Conclusions. We conclude that it is feasible and safe to administer active- passive bilateral therapy in a hospital setting. Keywords: Stroke, Upper Limb, Bilateral, Occupational Therapy. Poststroke upper limb hemiparesis is a common condition that physical therapists and occupational therapists address. Helping the Student with ADHD in the Classroom: Strategies for Teachers Introduction. Affecting three to five percent of the population, Attention Deficit. Muscle strength and flexibility are the key components to. Euthanasia conducted with the consent of the patient is termed voluntary euthanasia. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Although constraint- induced therapy has been found to be effective for patients with mild upper limb hemiparesis,1 bilateral training is considered a remediation technique for stroke survivors with moderate or severe arm hemiparesis. Bilateral training may consist of mirror image upper limb movements intended to exploit interlimb coupling dynamics. Bilateral priming is a neuromodulatory technique that evolved from bilateral training, which can be used to balance excitability between the cortices before training on unilateral tasks. The difference between bilateral priming and bilateral training is that, in the latter, bilateral movements are the actual training tasks, whereas in the former, bilateral movements render the motor system more susceptible to subsequent unilateral training. Neuromodulation may serve as an adjuvant therapy to improve synaptic efficacy during rehabilitation therapy. Neuromodulation of motor cortex has been achieved using repetitive transcranial magnetic stimulation,6 contralesional paired associative stimulation. A recent study used repetitive movement as a priming mechanism, comparing active- passive bilateral therapy (APBT) plus motor practice with motor practice alone in 3. The APBT consisted of repetitive mirror symmetric bilateral wrist flexion- extension that was performed for 1. Priming plus motor practice induced larger motor gains than motor practice alone, as assessed by Fugl- Meyer Upper Extremity (FMUE) scores. In contrast to the motor practice only group, the priming plus motor practice group retained their gains at follow- up. Also, priming plus motor practice induced greater normalization of short- interval intracortical inhibition and transcallosal inhibition than motor practice alone. Motor priming using APBT is noninvasive, and to date, no adverse effects have been reported. This study was funded by the Buchanan Family Fellowship for Occupational Therapy as a feasibility study to identify recruitment and compliance issues and to assess the rate of clinical score change in a small group of individuals admitted to inpatient rehabilitation after a stroke. Here, we describe the first documented use of APBT as a priming mechanism for individuals in the subacute phase of post- stroke recovery. METHODSApproval from the Internal Review Board of the university was received before recruitment and data collection. All possible participants and their families received an informed consent to read and sign. If reading was difficult, the research team read and explained the information on the consent form, including possible risks and benefits. Inclusion criteria consisted of unilateral stroke . There were three participants who completed one or two sessions of training and were discharged sooner than expected. There were six screen fails because of the FMUE scores. Two subjects could not be scheduled because of extensive rehabilitation services. One participant with significant medical needs (dialysis) could not be scheduled after the first training session. One participant (assigned to the control condition) refused because of reported pain. Four participants consented but then decided not to be in the study before beginning training. Four volunteers who met the study criteria were recruited. Two were assigned as “test (T)” patients and two as “control (C)” patients. FMUE scores of test participants were approximately matched to FMUE scores of controls. Two participants (T- 1 and C- 1) had relatively high baseline FMUE scores compared with other individuals in the subacute phase of stroke. The other pair (T- 2 and C- 2) had lower baseline scores. Characteristics of the test and control participants can be found in Table 1. Both test and control participants received 2. If scheduling did not permit two sessions per day, then only one session was completed. Also, if the participant strongly objected to a second session on any particular day, their preferences were respected. Test participants always received a 1. APBT before the motor training. The training was administered 5 days per week for 1–3 wks, depending on the participant’s length of stay. The duration of the motor training session (up to 3. The length of the motor practice sessions for each subject was averaged. The total numbers of sessions plus the average time per session are presented in Table 2. Both control and test participants also received the usual standard care treatment consisting of daily occupational therapy and physical therapy. Side effects such as wrist, elbow, or shoulder pain were monitored. Number and duration of sessions. APBT was administered to the test patients via a device called the Rocker (Criterion Manufacturing, Auckland, New Zealand) (Fig. Both hands are placed and strapped to two vertically oriented plates, which have a mechanical linkage. The vertical plate holding the less- affected wrist drives the plate holding the affected one through the linkage within the case of the Rocker. Participants were instructed to use the less- affected hand to move in rhythmic wrist flexion and extension in the horizontal plane (where gravity is eliminated). Automatically, the paretic hand is passively moved in a mirror image of the less- affected hand. The Rocker allows 1. It has a counter that sums the number of full repetitions completed. That number was recorded for each session. A person using the Rocker for active- passive bilateral therapy. Motor practice included two categories of activities based on task- oriented neurorehabilitation practice in occupational therapy. Category 1 consisted of exercises or tasks that were designed to improve joint stability, mobility, and strength as well as the transport phase of reaching. Category 2 consisted of activities and exercises that would support grasp and release. For each treatment day, the therapist selected two to four activities from each category. A list of the treatment activities is shown in the Appendix. Outcome measures included FMUE and Action Research Arm Test scores. For both scales, higher scores indicate less disability. For this feasibility study, all clinical assessments were conducted by an experimenter (M. E. S.) who was not blinded. Participants were evaluated before therapy, at discharge, and 1- mo postdischarge.
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