| Constraint Induced Movement Therapy (CIMT): LE | | |
Constraint induced movement therapy (CIMT) was intervention. The purpose was to determine if Motor Activity Log (MAL) and Wolfe Motor Function Test (WMFT) scores predicted self report of recovery at 4-6 months post CIMT. (Fritz, 2007) | | Regression analysis showed f/u scores were better predictors of recovery. Score of 1.15 on MAL predicted <50% recovery and > 2.5 predicted 50% recovery. WMFT >34.0 seconds predicted <50% recovery and < 11.0 seconds predicted >50% recovery. |
Participants wore a plastic whole-leg orthosis or a hyperextension bandage (splints turned to prevent knee flex) on the unaffected LE during cycling, pool training, functional strength training, load exercises w/ weight transfer, standing, stair training, indoor/outdoor walking on uneven surfaces 6h/day for 2 wks. Each training session lasted 1hr. (Marklund, 2006) | | More intensive exercise therapy for the LE can improve motor function (Fugl-Meyer), mobility (TUG), walking ability (Six-Minute Walk Test), & WB symmetry improves with immobilization of the unaffected LE. Follow-ups (3 & 6mo) showed continued/persisting improvements. Data analysis of results not listed/only participants' results. |
Participant received modified LE CIMT for 3hr/day for 2 wks. No constraint was applied to LE. Participant was encouraged to use more-affected LE in massed practice w/ various activities. (Pittman, 2006) | | Improvements were observed in all motor behavior tests: Questionnaires (2): improved balance confidence Sustained improvements at 1 mo follow-up Further experimental studies are needed |
The aim of the study was to determine if constraint-induced therapy was more effective than a less intense control intervention in changing motor function in post stroke patients The CI group had restraint of the unaffected UE for 6 hours a day and the control group aimed to improve task performance with the non-affected side (Wittenberg, 2003) | Design: Randomized control trial 16 patients had a single, subcortical infarction more than 12 months prior to the study, with significant functional impairment of the affected side indicated by a score of less than 2.7 on a motor activity log (MAL). Patients were randomized to a CI group of control group | Outcome measures were WMFT (a laboratory motor function test), MAL (a patient reported scale describing function), and AMPS (a real-time test in which patients perform prescribed functional tasks that were videotaped and scored) MAL increased by 1.08 after CI therapy and decreased by 0.01 after control therapy. The difference between groups was significant, which suggests that CI therapy led to a degree of increased use of the affected side in ADLs noticeable to the patient. Changes in WMFT and AMPS were not significantly different between groups |
| Constraint-Induced Movement Therapy (CIMT): UE |
Over 4 weeks the modified constraint-induced movement programme (kid-CIMT) group received 60 hours of unilateral constraint-induced therapy followed by 20 hours of bimanual training; while, the intensive bimanual training (IBT) group received 80 hours of bimanual training. Frequency: 60 minute sessions, four times a day, 5 days a week (Deppe, 2013) | Randomized controlled, single-blind trial Unilateral cerebral palsy or other non-progressive hemiplegia (n=47) Age: 3.3-11.4 years | On the Melbourne Assessment of Unilateral Upper Limb Function, both groups showed significant improvement; however, the kid-CIMT group resulted in significantly better affected arm and hand isolated targeted movements compared to the IBT group (P=0.033). On the Assisting Hand Assessment: Both groups showed significant improvements in everyday spontaneous hemiplegic hand use; however, there was no difference between groups. Outcomes especially in the kid-CIMT group were affected by severity of disability with the more severely impaired children showing a greater improvement. |
mCIMT combined with bimanual training (BiT) during 3 hr sessions, 3 days/week for 8 weeks. 50% of the training was individual PT or OT and the other 50% was given in small groups. Therapy consisted of shaping and repetitive task practice. Unaffected arm was restrained for the first 6 weeks. The last 2 weeks consisted of goal-directed task-specific BiT without any restraint. The usual care group received a regular rehabilitation program consisting of individual PT and/or OT twice a week in 0.5 to 1 hr sessions (total therapy: 1.5 hr/week) for 8 weeks. Another 7.5 hr/week stimulation of bimanual hand use was given at home or in pre-school groups according to pre-determined instructions. (Aarts, 2010) | Randomized Controlled Trial children ages 2.5 – 8 years unilateral spastic cerebral palsy mCIMT (n=28), usual care (n=24) | Significantly greater improvements in upper limb capacity and performance after mCIMT-BiT compared to usual care which lasted up to 8 weeks follow-up There was a significant reduction in developmental disregard only in children with poor manual ability at baseline (MACS III) No significant changes were found in active or passive ROM |
A combination of constraint-induced movement therapy (SMR) and motor control retraining were behavioral interventions utilized to treat focal hand dystonia (FHD) of musicians The aim of the study was to determine the effects of a combined behavioral therapy intervention over 12 months in 8 musicians with FHD (Berque, 2010) | Design: repeated measures Subjects: N = 8; all were affected by FHD and volunteered, 6 were professional musicians, 2 were amateur musicians, only one female Frequency of abnormal movements (FAM) was measured: day 1, day 8, then every 2 months for 12 months. | A retraining protocol combining SMR and motor control retraining led to significant improvements in FAM over time Retraining had to be carried out for at least 8 months before significant FAM score changes were noted FAM scale showed excellent intra-rater reliability and good inter-occasion reliability within a repeated-measures design |
The client participated in a 3 week CIMT program in which her left upper extremity was restrained. The program consisted of an intense training of her right upper extremity. The primary techniques for training were task practice and shaping. The functional outcome measures were the Motor Activity Log, Graded Wolf Function Test and the Fugl-Meyer Evaluation. (Bonifer, 2003) | | The scores on the Fugl-Meyer did improve between pre-treatment and post-treatment by three points on the UE score. However, the scores did not increase after one month and six months. The Wolf Motor Function Test scores did not change significantly between post-treatment, one moth follow-up and the six-month follow-up. MAL scores did increase post treatment. However, but returned to baseline after one month follow-up and six months follow up. |
CIMT conducted in a group format in patients with chronic stroke. Objective of study was to determine if CIMT used in a group setting would be as effective as in one-on-one scenario, while also decreasing the demand on therapist resources. Intervention group wore mitt on uninvolved UE for 90 % of waking hours / 12 days. Each group session consisted of 2-3 patients per therapist for 6 hrs / day of group training. After the 12 day tx period, groups were (again) randomized into receiving 3 mo additional treatment or no additional treatment at all. (Brogardh, 2006). | Combined case-control and randomized CT Patients with chronic stroke and moderate motor impairments in contralateral. UE (n=16). Intervention group wore mitt on uninvolved UE for 90 % of waking hours / 12 days. Each group session consisted of 2-3 patients per therapist for 6 hrs / day of group training. | Intervention group: patients improved significantly in mean motor performance of involved UE after 2 wks of CIMT No sensory change in 2-pt Discrimination Test Patients showed no additional effect from wearing mitt for extra 3 mo. |
CIMT conducted on a pediatric (CP) population. Consisted of a "child-friendly" form in which participants wore a sling on their uninvolved UE for 6 hrs per day for 10 out of 12 consecutive days. During this time, children were engaged in functional play activities. (Charles, 2006) | Randomized controlled trial Involving children with hemiplegic CP. Participants were divided into an intervention group and a delayed treatment control group. N=22 | Intervention group: showed improved movement efficiency & dexterity of involved UE (sustained through 6 mo evaluation period). No change in strength, sensibility, or muscle tone of involved UE. |
Long term effects of constraint-induced therapy (CIT) were compared to traditional rehabilitation (TR) in a pediatric population (CP). Both groups took part in 4 weeks of an individualized home-based intervention program from a PT for 3.5 to 4 h/d twice a week. Children in the CIT group wore an elastic bandage and restraint mitten with hours documented by parents. (Chen, 2014) | Randomized controlled trial Children with unilateral CP (age 6-12) (n=45) Participants were randomly divided with 23 in the CIT group and 22 in the TR group. Patients were assessed using subtest 8 of the BOTMP, PDMS-2, and the WeeFIM as well as a reach-to-grasp task. Pre-test CIT group: "greater normalized movement unit and lower percentage of movement where MGA occurs than the TR group." | Both groups increased from baseline on the PDMS-2, subtest 8 of the BOTMP, and WeeFIM. CIT group improved more on PDMS-2 at post-test and showed greater improvement at 3- and 6-month follow-up for all three outcome measures. Both groups improved in reach-to-grasp kinematics; CIT group had greater improvement in: normalized movement time at post-test and follow-ups, normalized movement unit at 6 months, and MGA was greater at post-treatment. CIT group had greater gains in temporal and spatial efficiency than the TR group at 6 months post-treatment. |
14-day treatment study 2 hours/day, 5days/week, for 2 weeks. CI therapy subjects wore a padded mitten 6 hours/day & received treatment focused on ADL's and CI circuit training. Control subjects received treatment for ADL's, UE ROM, strength, & positioning (Dromerick, 2000) | Pilot randomized controlled trial Comparing CI therapy with traditional therapies Inclusion criteria: persistent hemiparesis, ischemic stroke (n=23) within 14 days, protective motor response, & preserved cognitive function | Action reach arm test (ARA) scores were significantly higher for CI therapy patients after the 14 day treatment (F=11.70, p<0.003) Pinch subtest score significantly improved (U=13.50, p<0.03) Grip, grasp, and gross motor subscale scores were not significant |
CIMT using a resting hand splint on the less affected arm (≈9.3 hr/day), patients performed intensive motor training (repetitive daily activities) using the affected arm for 3 hrs/day for 20 days (Dettmers, 2005) | | Using the Motor Activity Log (MAL), participants reported a large improvement in the amount of use of their impaired arm, 1.7±0.8 points pre treatment to 3.6±0.9 points post treatment Using the MAL, participants also reported a large improvement in quality of movement with the more affected arm, which was 1.8±0.9 points pre treatment to 3.2±0.9 points post treatment Upper limb motor activity improvements were also noted using laboratory tests, such as the WMFT and FAT Associated improvements: Grip strength also improved (avg. improvement 4.2±3.1 kg); Spasticity decreased (avg. decrease 0.3±0.4 points) Quality of Life (QOL) scores improved after 6mos post treatment, using the SIS |
Patients were placed in the sling-constraint group or the voluntary constraint group. Both groups participated in massed practice of the paretic arm for 6 hours a day for 3 weeks with physical therapists. (Krawczyk, 2012) | | Both groups showed improvement in their scores on the MAL-QOM and RMA There was no significant difference between groups (p= .687) Both groups still showed their gains at the 12 month follow up |
CI therapy consisted of 6 hours/day UE training for 2 weeks with a restrictive mitt on the contralateral UE during waking hours. Functional MRI was performed while subjects attempted sequential finger tapping (Levy, 2001) | | |
mCIMT & reach-to-grasp: Control group received traditional therapy & the experimental group received mCIMT. mCIMT consisted of: restriction of movement of the unaffected hand for 6 hr/day & intensive training of the affected arm for 2hr/day. Typical activities included: picking up marbles, flipping cards, stacking blocks, & combing hair. Traditional therapy included: strength, balance, fine motor dexterity training, functional task practice, & stretching/WB by the affected arm. Both groups received treatment 5day/wk for 2hr/day for 3 consecutive wks. (Lin, 2007) | Two group randomized controlled study w/ pre/post treatment measures Chronic hemorrhagic stroke (16.3 mo post) ≥ Brunnstrom stage III in proximal/distal arm No excessive spasticity in arm Avg age = 57.9 Control n=15, experimental n=17 n=32 | Moderate & significant effects of mCIMT on motor control of reach-to-grasp & on functional ability Preplanned reaching & grasping (p<0.018) more efficiently than control Depended more on the feedforward control of reaching than the control group (p<0.046) Significantly improved Motor Activity Log (p<0.0001) Significantly improved Functional Independence Measure (p<0.016) |
The participants completed 2 weeks of constraint-induced therapy for 6 hours a day. They were to wear a padded mitt on their unaffected UE for 90% of waking hours. The participants did activities playing checkers, washing windows, and stacking blocks, are were given 5 minute rest breaks as needed. (Massie, 2009) | Exploratory study, pre/post study Patient with Left CVA (n=10); 3 female and 5 with left CVA; mean age of 61 At least 9 months post stroke and had to have a clinical presentation of at least 10° of active wrist extension and 10° of extension in at least 2 fingers and thumb; approximately 30° of active shoulder flexion; at least half the normative passive range of motion at all upper extremity joints; ability to follow simple instructions and multistep commands; endurance to complete 6 hours of training | Stroke affected reach: shoulder flexion increased (p = .034), trunk movement decreased but was not significantly different (p= .67), elbow extension did not significantly increase (p= .22) Shoulder abduction as a compensatory movement- the amount of shoulder compensatory abduction decreased slightly but there was not significant difference noted (p=.9) Functional Outcome: Wolf Motor Functional test: time of the test decreased (p= .014) and the functional ability of the test improved (p=.014) Overall outcome of the study: CIT did not help the patient overcome the compensatory movements or synergy dominant activities that they used. |
CIMT using a mitt worn 90% of waking hours, signed a behavioral contract, received activity-based home program 6 hours a day for 2 days a week and OT for 6 hours a day for 3 days a week for 2 weeks (Roberts, 2004) | | Significant improvements were shown in weight lifted using the WMFT (p=.013) After treatment improvements in total time for completing the WMFT were made (p=.215) Significant improvements were made for both performance and satisfaction scores using the Canadian Occupation Performance Measure (COPM) |
Intensive Training similar to the learning principle of "shaping" with CIMT, 1 treatment group, 90 minutes/day for 3 weeks (Sterr, 2003) | | |
CIMT (14 consecutive days; for a target of 90% of waking hours) with either 6 hours (6h/d group, N=7) or 3 hours (3h/d group, N=8) of shaping training with the affected hand per day. (Sterr, 2002) | Randomized controlled trial 2 groups: 6 hr/d shaping group (n=7) and 3 h/d group (n=8) baseline, pretreatment, and post-treatment measures 1-month follow-up of chronic stroke patients n=15 | |
CIMT using a light-weight sling during exercises and during all free time (monitored use by body-temperature sensor), 2 groups: 1 treatment group, 1 control group, 7hrs/day for 10 days (out of 2wk period) (Tarkka, 2005) | | At the end of therapy, total time for completion of the WMFT was significantly reduced in the treatment group (p<.001) Treatment group's scores on WMFT improved for functionality (p<.001) and quality of movement (p<.001) Treatment group's handgrip force also improved significantly (p<.01) |
A treatment trial of CI therapy on patients with mild to moderate Parkinson's (Tuite, 2005) | Open-label nonrandomized pilot study treatment trial Parkinson's patients (n=6); Hoehn & Yahr stage II /III; right handed, right sided symptoms | |
CIMT used with patients who sustained an ischemic stroke within the past 3 to 9 mo. (Wolf, 2006) | A prospective, single-blind, randomized clinical trial "EXCITE" conducted at 7 US academic institutions. Participants with stroke (n=222) displaying some hand and wrist ROM of involved UE prior to treatment; (106 receiving CIMT, 116 receiving customary physical therapy). | Between group difference: (CIMT) improvements: Wolf Motor Function Test (WMFT) Performance Time reduced 34% (95% CI:12-51%; p<0.001), MAL amount of use increased 0.43 points (95% CI:0.05-0.80; p<0.001) MAL Quality of Movement improved 0.48 points (95% CI:0.13-0.84: p<0.001 self-perceived hand function difficulty reduced 9.42 points (95% CI:0.27-18.57; p=0.05) The experimental group improved more & showed more significant improvements compared to the control group. |
Does distributed constraint-induced therapy (with and without trunk restraint) lead to improvement of motor function, daily activities, and quality of life (compared to control). The dCIT groups received 2 hour sessions, 5 days per week, for 3 weeks. The control group received care that emphasized weight bearing, strengthening, and stretching of the affected arm. Motor function daily activity level, and quality of life were assessed using the following outcome measures: Action Research Arm Test (ARAT) for motor function Motor Activity Log (MAL) for daily function, Frenchay Activities Index (FAI) for performance of ADLs, and Stroke Impact Scale (SIS) for quality of life. Degree of individual joint fractionation was measured using a VICON MX 7 camera motion analysis system, to evaluate kinematic data. (Wu, 2012) | Design: single blind, randomized control trial Patients with stroke (n=57), 6-55 months prior to the study who had residual motor function of the affected UE (≥15 on the Fugl-Meyer Assessment), considerable nonuse of the affected limb (<2.5 on MAL), no excessive spasticity (Mod-Ashworth Scale ≤2), and no cognitive deficiencies (MMSE ≥24). Outcomes were assessed once before, and once after the 3-week intervention protocol. | ANCOVA showed significant differences in ARAT grip subscale and total scores among groups. dCIT-TR group had more improvements in grip function than other two groups—dCIT (p=.02) and control group (p=.01). ARAT total scores improved more in dCIT-TR (p=.02) and dCIT (p=.04) groups than control group, indicating an improvement in motor control. dCIT-TR (p=.03) and dCIT (p=.01) groups had higher quality of movement subscale score of MAL, which correlates with daily function. The dCIT-TR (p=.01) and dCIT (p=.04) groups exhibited significantly higher FAI total scores than the control group, indicating a correlation in functional improvement in ADLs.. Results for the ADL and mobility domains of the SIS were not significantly different than controls. |
Participants were randomized into three groups: distributed constrain-induced therapy (dCIT), bilateral arm training (BAT), and control treatment (CT). Over the three week period, participants received treatment 2 h/d for 5 d/wk. Participants were evaluated using the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and kinematic variables in unilateral and bilateral tasks. (Wu, 2011) | Randomized pretest and posttest control group design. Participants (n=66) had a mean age of 53 and 16 months mean time since stroke onset. Participants were Brunnstrom stage III or above for proximal and distal UE. | dCIT and BAT groups showed significant improvement in smoothness during kinematic tasks compared to the CT group. dCIT group had significantly greater improvements in WMFT-Time and WMFT-FAS than the CT group and higher gains in MAL-AOU and MAL-QOM than both groups. No clinical measure showed significant differences between the CT and BAT groups. BAT group significantly improved force generation at movement initiation during unilateral and bilateral tasks compared to CT. |
Modified constraint induced therapy (mCIMT) "Shaping" was primary treatment. Functional tasks were selected to address motor deficits in the affected arm. Tasks were gradually progressed in small steps with immediate feedback for improved movement quality. Sessions: 2hours/ day, 5 days per week x 3 weeks. The unaffected hand was restrained in a mitt for 6 hours per day. *The control group received traditional rehabilitation (TR) at the same intensity/duration (neurodevelopmental training, stretching, weight bearing through affected limb fine motor tasks and ADL training with unaffected side. (Wu 2007) | | Bimanual tasks: mCIMT had shorter movement time (MT) (p=.013) and total displacement (TD) (p=.011)(efficiency of hand's path in 3-D space) and increased peak velocity (PPV) (p=.0009). (A lengthened PPV is due to longer acceleration of the hand, indicating less error correction and better preplanned control of reaching.) |
| | Subjects: N=30were 12-36 months post CVA. Inclusion criteria consisted of several specific requirements to ensure significant deficits of the limb yet maintain capacity to participate in tests. Evaluation was made on 2 tasks: Unilateral- reaching to ring a bell with affected hand Bimanual- opening drawer with the affected hand and grasping an object with the other. Tests were timed and kinematic analysis was performed with video motion analysis camera. | |
Effect of trunk restraint on UE movement post stroke Randomized into two groups, all wore a mitt on uninvolved hand 90% of day. Treatment group used a device to restrain anterior trunk movement. Intensive task practice with and without device. (Woodburg, 2009) | Randomized experimental Patients with single, unilateral stroke at least 3 months prior (n=11); 5 healthy control subjects; Fugl-Myer UE assessment scores of 26-54 and WMFT; Able to actively extend wrist, 2 fingers and thumb 10 degrees Randomized stroke patients into modified CIMT with and without trunk restraint | Trunk-restraint group (TRG) produced straighter reach trajectories (p=.000), less trunk displacement (p=.001), TRG improved voluntary shoulder flexion and elbow extension (p=.006 and .022). Efforts to decrease excessive trunk movements during UE tasks can promote more normal UE movements. |
Comparison between CIMT and traditional intervention on UE function Both treatments lasted 2 hr/day 5 days/week for 3 weeks All subjects received routine interdisciplinary stroke rehabilitation separate from the study treatment. CIMT included putting the more affected UE through functional exercises including pushing, grasping, and lifting activities, while the less effected UE was placed into a mitt for 6 hours a day. Traditional Intervention involved a neurodevelopmental therapy consisting of functional task retraining, stretching, weight bearing, and fine motor training of the more affected UE 1.5 hrs/day 5days/week. (Wu, 2007) | Randomized Controlled Trial Patients with stroke (n=47): 32 men, 15 women; mean age 55 yrs (40–80). -CIMT group: n=24 (16m 8f); Traditional group: n=23 (17m 7f). Inclusion criteria: able to reach Brunnstrom stage 3 with proximal UE, MAL AOU <2.5, no balance or cognition problems, and lack of participation in any experimental rehab or drug use within the past 3 months Comparison of groups using analysis of covariance. | CIMT group showed more preprogrammed movement after treatment than the Traditional Intervention group. CIMT group showed better strategies of reaching control than the control group (P_.03). CIMT group showed less motor impairment on the FMA (p=0.019) and higher functional ability on the MAL (p=0.001). |
Constraint-induced movement therapy (CIMT), including shaping, task practice, and behavioral strategies, was performed 10 consecutive workdays, 3 hrs/per day, with a mitt worn on the unaffected hand for 90% of waking hours, emphasizing task-oriented training. Control group treatment was based on Norwegian guidelines for stroke patient treatment. (Thrane, 2015) | Single-blinded randomized multisite trial Individuals with stroke (n=47) onset < 26 days prior to study; MMSE >20 Subjects randomized to CIMT or control group Outcome measures (Wolf Motor Function Test, Fugl- Meyer upper-extremity motor score, Nine-Hole Peg test (NHPT) score, the arm use ratio, and the Stroke Impact Scale (SIS)) were taken at baseline, after the 2 week treatment, and at 6 months post treatment | The mean timed Wolf Motor Function Test score of the CIMT group was significantly greater (p=.018) than the control group after the 2-week treatment Using the Nine-Hole Peg test, The CIMT group had significantly greater (p=.035) dexterity than the control group after the 2 week treatment At the 6 month follow up, there were no significant differences between the two group in any of the outcome measures |
Constraint induced movement therapy (CIMT) was compared to motor relearning programme (MRP) to improve motor function. The CIMT group was constrained from using the unaffected limb during therapy by donning a mitt on that hand during repetitive tasks to include: stacking cones and blocks, grasping and releasing, reaching forward and sideways, and lifting and dropping items. The MRP group was allowed to use both limbs in combined tasks to include: opening a jar, weightbearing on the hemiplegic side, and tasks involving bilateral limbs. Each group received their respective therapy in six 2-hour sessions per week for 3 weeks. (Batool, 2015) | Randomized controlled trial Subjects with UE hemiplegia (n=42) from ischemic or hemorrhagic stroke in Pakistan, 2-weeks to 3 months post-stroke; were randomized to 21 in CIMT and 21 in MRP groups. Outcome measures: UE portion of the Motor Assessment Scale (MAS), Functional Independence Measure Scale (FIM). | Both groups improved significantly (p <0.05) in UE portion of the Motor Assessment Scale and All components of FIM except dressing upper body portion pre/post intervention. On the FIM, the improvement of the CIMT group was insignificant on the dressing upper body portion and the improvement of the MRP group was insignificant on the grooming and dressing upper body portion pre/ post interventions. Between group analysis showed CIMT was significantly more effective than MRP in all outcome measures (all p= <.05) except dressing the upper body contained within the FIM (p = .059). |
Home-based constraint-induced therapy (CIT) compared in younger and older subjects. One physical therapist treated all subjects using CIT for two 4-hour sessions per week for 4 weeks. During these sessions, the lesser affected limb was put into a mitt to require the subject to use the more affected limb during tasks the PT selected based on the subject plan of care. The mitt was to be worn for 4 hours per day all of other days outside of therapy. The ultimate goal was to accrue 112 hours of constrained use for the duration of the program. (Chen, 2016) | Extended analysis of randomized controlled trial Children with cerebral palsy (CP) (n=23) including 6-8yo group and 9-12yo group. Outcome measures: Peabody Developmental Motor Scale – Grasping (PDMS-G) and Visual motor integration (PDMS-VMI) subscales, WeeFIM self-care and reach-to-grasp kinematics | Both groups showed a significantly positive improvement (p<.05) in all outcome measures. The younger group score significantly higher than the older group on the PDMS-VMI at the 3- and 6-month follow-up. PDMS-G, WeeFIM, and reach-to-grasp kinematics did not differ statistically between groups after intervention. Given the findings, this study provides weak evidence supporting the need for early intervention of children with CP using CIT. |
| Forced Use Therapy (FUT) | | |
Clinical FUT applied to stroke patients. Group 1: conventional rehabilitation. Group 2: conventional rehabilitation plus FUT wearing a thick constraint mitten on the sound arm, beginning with 1 hour a day and increasing to 6 without additional "shaping" therapy very little additional therapist intervention (Ploughman, 2004) | Randomized controlled trial Patients with CVA (n=23); 38 days post first CVA; mean age 61. 2 groups: Inpatients or outpatients; control group (n=13) and FUT group (n=10) Patients showing minimal movement of the arm and hand and having greater motor impairment and disability at study onset than subjects in previous studies | |
| Therapeutic Exercise |
The treatment group completed an aerobic exercise intervention, consisting of warm-up and equal times on cycle and treadmill, over 3x/wk for 16 weeks, progressing exercise time from 10 minutes each exercise (weeks 1-4), 15 minutes each (weeks 5-8), to 20 minutes each (weeks 9-16). All exercise was preceded by a 3-minute cycle warm-up and 5 minute stretching. Movement initiation time for elbow simple (flexion and extension) and choice (either) conditions was measured. (Bergen, 2002) | Randomized controlled trial 3 groups of patients with PD (n=8): 1 group with 4 PD subjects completed aerobic exercise intervention, 1 group with 4 PD subjects used as control (only tested for aerobic capacity and movement initiation), 1 group of 6 healthy subjects (n=6) used as a control (only tested for movement initiation) Patients with PD classified as a 2 on the Hoehn and Yahr scale One way ANOVA used to compare groups Repeated measures ANOVA for treatment group, pre- vs post-test 2 x 2 ANOVA analyzed aerobic capacity | Aerobic exercise may reduce the detrimental effects of neuromuscular slowing in PD by improving the patient's decision-making ability to initiate and perform appropriate movement patterns Max VO2 significantly improved in the treatment group (19.5-24.5, 26%) Control group's VO2 max declined slightly from 15.9ml/kg/min to 14.1 ml/kg/min Treatment group's power output significantly increased from 123 to 163 watts Control group had a 10% reduction, 109 to 98 watts in power output Treatment group improved motor initiation (MI) time for both simple and choice conditions, choice mean time 532ms pretest to 415ms posttest, simple mean time 285ms pre to 261ms post Healthy subject MI times were: choice 409ms and simple 222ms, which was close to the treatment group's times. |
Each subject participated in a single-session experiment to assess delays in grip initiation and termination using EMG signal. A trial consisted of subjects relaxing fingers for 5 s, gripping maximally for 5 s, and relaxing the hand for 20 s without moving location of the hand. Auditory cues were used for stopping and starting grip initiation. EMG electrodes were placed on the flexor digitorum superficialis and extensor digitorum communis. EMGs were recorded during the 30s trial at 500 Hz. Grip locations, arm support, and stretching conditions were varied among trials (6 different conditions). Three trials were performed for each condition with a break of ≥1 minute between trials. Stretching consisted of 30 min of active manual muscle stretch, holding the end position for ≥5s. Each stretch was repeated 10 times. Participants then performed grip and relax trials. (Seo, 2009) | Non-randomized controlled trial Subjects with chronic hemiparetic stroke (n=10); 7 males and 3 females, at least 9 months poststroke 5 neurologically intact control subjects (n=5); mean age of 51 years Stroke subjects: no cognitive dysfunction precluding comprehension of task and stage 2 to 3 on Chedoke-McMaster stage-of-hand scale; mean age was 51 years (range from 39 to 68 years) 7 stroke subjects had left side involvement while 3 had right side involvement | After repeated active muscle stretch protocol, mean delay in grip initiation decreased 32% on average (∆0.490s) (p<0.05). Grip location and arm support did not significantly affect delay in grip initiation (p>0.05). Delay in grip termination varied significantly for arm support (p<0.05) and repeated active muscle stretch (p<0.05), but not for grip location (p>0.05). Use of arm support resulted in 37% decrease in grip termination delay (∆2.596s) |
All subject received conventional physiotherapy according to the Bobath concept (45 min daily) and occupational therapy for activities of daily living for 4 weeks. Group 1: also received repetitive hand and finger flexion and extension exercises against various loads and twice daily during 15-min periods the entire time. Group 2: also received TENS to extensor carpi ulnaris for 2 weeks and then received the specific therapy. Treatments were conducted twice daily during 15-min periods. (Bütefisch, 1995) | | Paired t-test revealed a significant increase of the RMA from the end of the baseline phase to the end of the training phase in both patient groups (t = 2.93, p < 0.05 for group 1; t = 5.52, p < 0.001 for group 2), with the greatest increase during the training phase for each. The measured motor parameters (grip strength, peak force, peak acceleration) revealed no statistically significant changes during the baseline phase and during the TENS phase in group 2, but a significant improvement during the training phase of both groups. |
The 8 week session NYPH Outpatient PT PD Group Exercise Program which met for 1hr/week and was lead by 2 PTs. Included the following: seated warm-up, functional activities, flexibility, and strengthening ex. of entire body often with multi-segment movement, stressing deep breathing and anti-gravity plane of motion. Music accompanied all sessions. (Curtis, 2001) | | Post-exercise improvement was noted for some of the SF-36 scales, but changes were not systematic across subjects. At completion of the program, all subjects demonstrated a reduction in movement time on the Posturo-Locomotion-Manual (PLM) test, although, the mechanism of improvement varied dependent upon pathology. For the timed walk task, 2 subjects improved and the other 2 had no significant change. |
Therapeutic exercise, consisting of strength, balance, and endurance activities for 90min, 36 sessions over 12-14wk period, 2 groups: 1 group received exercises above, 1 group received usual care, which were services prescribed by the subject's physician (Duncan, 2003) | Randomized controlled single-blind clinical trial Individuals 3-28 days post-stroke (n=92) diagnosed by MRI or CT scan; mean age 70 mean Orptington score 3.4 | At 3mo from baseline, both groups improved in strength, balance, UE & LE motor control, UE function, & gait velocity Usual care group did not show gains in endurance Treatment group had better improvements than the usual care in endurance (VO2 max and duration of exercise), balance (Berg Balance), 6-minute walk distance, and gait velocity Treatment group's UE motor function, based on the Wolf Motor Function Test (WMFT), improved |
Experimental group received a therapeutic intervention & sensorimotor stimulation (seated in rocking chair with air splint on affected arm, such that rocking movements required the patient to actively push backward through their arm) for 30min, 5days/wk for 6 wks. Same activity for control group, but arm positioned gently in lap. (Feys, 1998) | Single-blind, randomized, controlled multicenter trial Patients 2-5 wks post ischemic/hemorrhagic stroke (n-100); avg. age=65.62; avg. Brunnstrom-Fugl-Meyer score <46 2 groups: control group (n=50) & experimental group (n=50) | In the experimental group improvements were seen in: Brunnstrom-Fugl-Meyer significantly improved 7.3 points at 6 mo (p=0.004) & 6.5 points at 12 mo (p=0.03) Action Research Arm Test & Barthel Index showed improvements over time, but it was not statistically significant. Treatment was most effective in pts w/ severe motor deficit (P=0.04) & hemianopsia/hemi-inattention (p=0.02) These improvements were attributed to the repetitive stimulation of muscle activity. |
Pts. randomly allocated to 1 of 3 groups receiving: 45 minutes routine physiotherapy vs. routine + 2 hours extra treatment by a qualified physiotherapist (QPT) (Bobath approach), or routine + 2 hours additional treatment by a physiotherapy assistant (APT.) (Lincoln, 1999) | Single-blind, randomized controlled trial stroke patients (n=282) admitted to a hospital within a median of 12 days post-stroke Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living | All patients in the study improved, but there was no detectable benefit in acute stroke patients in their upper-limb motor function or ADL ability in either of the groups with increased treatment time. About half of the QPT and APT patients (n=91) did not complete 10 hours of additional treatment. |
This study examined the effects of power training (PWT) on participants diagnosed with idiopathic Parkinson's Disease. The PWT program consisted of varying training loads, increasing weekly. The program used 11 pneumatic weight machines, as well as two weeks of "translational training cycles," consisting of balance and agility activities to improve speed and coordination in the participants. Pneumatic weight machines: Biceps curl Triceps push down Chest press Seated row Lat pull-down Shoulder press Les press Leg curl Hip abduction/adduction Seated calf The control group attended health education classes and were supposed to maintain their existing exercise routine. (Ni, 2015) | Design: randomized control study Subjects: adults diagnosed idiopathic Parkinson's Disease (n=24); H&Y stage I-III, age 60-90, ability to ambulate 50 ft., min assist for sit to stand from the floor. (14 PWT group and 10 control group). Outcome measures: Bradykinesia scores for the upper and lower limb were obtained from the United Parkinson's Disease Rating Scale (UPDRS) motor exam items. | Although the control group showed slight improvements, there were significant improvements found in UE and LE bradykinesia scores, and muscle strength and power on all five machines tested in the PWT group. The participants in the PWT group reported significant improvements on their quality of life questionnaire. PWT is a feasible route to increase physical function in patients with Parkinson's Disease. |
All subjects: group therapy for 19 weeks (1hr sessions, 3 sessions/wk in a community hall. Group 1: UE Ther-ex (including wrist extensor e-stim, functional Training, etc.) Group 2: LE Ther-ex (incl. cardio, balance, etc.) (Pang, 2006) | Randomized non-controlled study Community dwelling people (≥50y) with chronic deficits resulting from stroke (n=63); onset ≥1yr; independent or MI in ambulation The subjects ranged from mild-severe functional deficits | 95% of subjects were able to complete the program & most reported enjoying the social interaction The Wolf Motor Function Test (WMFT) & Fugl-Meyer Assessment (FMA) revealed greater improvement of the arm group Only subjects in the arm group improved significantly |
Bilateral training in stroke Patients received training in bimanual copying exercise, using a digitized pen and writing board to track timing and correctness. Sessions: Daily training sessions for 5 to 8 weeks (between 25 to 40 sessions each depending on patient availability). For the first 10 sessions each session started with a baseline of copying 3 designs (a line, circle and triangle) that were kinematically analyzed. Upper body was stabilized to prevent substitution. Exercise was 20 repetitions of copying each shape. In the second phase bilateral copying was performed with 1 of the shapes initially and other shapes were added gradually. (Tijs 2006) | Design: Five single case experiments using within participant multiple baseline design. Subjects: 5 volunteers with residual unilateral paresis of upper extremity following CVA. Inclusion criteria: severity of paresis: no spontaneous use of affected arm in ADL's, Min Mental State exam score of 24/30. | Quality of movement was analyzed 3 ways: temporal performance: jerkiness of writing, speed and duration; spatial performance: accuracy of copying the shape; posture: measured by degree of pen tilt. Following intervention period, no improvement was found in quality of movement in affected limb. |
Standard care (SC), functional task practice (FT), and strength training (ST). FT and ST groups received 20 additional hours of upper-extremity therapy (Winstein, 2004) | Non-blinded, controlled trial Patients admitted for inpatient rehabilitation post-CVA (n=64) and were randomized within severity strata (Orpington Prognostic Scale) into 1 of 3 intervention groups | Compared with SC participants, the FT and ST groups had significantly greater increases in Fugl-Meyer scores (p=.04) and isometric torque (p=.02) post-treatment. Benefit was primarily in the less severe participants (Fugl-Meyer doubled that of the SC group). Similar results found for function (FTHEU) and isometric torque. At 9 months, the less severe FT group continued to make gains in isometric muscle torque, significantly exceeding those of the ST group (p<.05) |
Influence of gravity compensation on UE movement patterns of stroke patients- 3D functional reaching patterns Performed reach and retrieval tasks repeatedly with and without unloading using a device at the elbow and forearm to compensate for gravity. EMG was used on 6 muscles of the shoulder and elbow to record activation. (Prange, 2009) | Eight patients with mild hemiparesis Fugel-Myer scores of a max of 66 Non-blinded and no control group Patients must be at least 4 weeks post stroke, able to partially lift arm against gravity and have no arm pain Pooled data analysis | Gravity compensation did not alter motor control but did decrease muscle output, EMG values of 25% to 50%. Use of gravity compensation during functional activities and exercise can decrease overall muscle output and allow the patient to focus on completing the task rather than muscle output of a weak muscle. Study findings are supportive of other therapies such as robot-assisted exercise. Study limitations of no control group and no treatment comparisons done. |
Investigated the effect of inertial loading on essential tremors(ET). Used no-load, 5%, 15%, 25% 1 repetition maximum on the wrist of subjects with the UE outstretched. A high precision laser displacement sensor was used to measure tremors. EMG sensors also used on the extensor carpi radialis brevis (Heroux, 2009) | 22 subjects with ET were divided into two groups based severity of tremor 22 healthy subjects acted as control group ET subjects were blinded to their arm during the test | |
Unilateral and bilateral reaching was performed. Bilateral reaching using various loads based on the nonparetic arm. (Harris-Love, 2005) | Cohort study Subjects with chronic stroke (n=32) F-M scores of 37+/- 14 Electromagnetic tracking system recorded peak hand accleration, velocity and movement time α=0.05 | |
Subjects completed six hours of daily intensive exercise for two weeks (10 consecutive weekdays) with focus on weight-shifting towards the affected side and increased use of the affected extremity during functional activities. An insole with nubs in the shoe of the non-paretic limb was used to reinforce weight-shift toward the affected side. Outcome measures included Timed Up and Go, Four Square Step Test, gait velocity, gait symmetry and muscle strength in knee and ankle muscles (Stock, 2009) | One-group pre- and post-test experimental design Pilot study Patients with Hemiparesis (n-12) At least six months post stroke Age 18-65 years Able to ambulate 20 cm | No significant difference between pre-test 1 and pre-test 2 for any variables (p>0.11) All variables showed excellent test-retest reliability between the two pre-tests (except special symmetry during max velocity) Max gait velocity (p=0.002) increased significantly from pre-test 2 to post-test and from pre-test 2 to one-year follow-up Performance time on Timed Up and Go and Four Square StepTest improved from pre- to post-test (p=0.005). Preferred gait velocity and gait symmetry remained unchanged Max isometric strength increased significantly from pre-test 2 to post-test for knee extensors (p<0.009) and flexors (p<0.001) on both sides. Max isometric strength increased for both dorsiflexors and plantar flexors on the paretic side. |
Eccentric Resistance Training: 12-week program of high intensity eccentric resistance training of the quadriceps. Both control group and experimental group underwent 12 weeks of traditional evidence-based rehabilitation for Parkinson's Disease. In the experimental group traditional strengthening was substituted for high intensity eccentric resistance training. Outcome measures used include UPDRS, maximal voluntary isometric force (MVIC), TUG, and TMW (measure of the speed a person walks over a 10m distance) (Dibble, 2009) | Design: Controlled clinical study Subjects with PD (n=10) 10 subjects were allocated to a control group and 10 subjects were allocated to an experimental group Hoegn and Yahr stages 1-3 | There was no significant difference between the two groups scores on the UPDRS. MVIC increases demonstrated in the experimental group exceeded those in the active control group in both their more affected and less affected extremities (less affected p=0.01; more affected p=0.01) There was significant time by group interaction effects for both the TMW and TUG tests (TMW p=0.02; TUG p=0.03) This study supports the inclusion of high intensity resistance training as a critical component of exercise interventions for people with PD to improve strength and bradykinesia. |
Parkinson patients completed 40 minutes of active-assisted cycling, with pre and post measures of CV variable as well as resting tremor and movement speed (Ridgel, 2012) | | 40 minutes of AAC resulted in a tremor that was not significantly different than during the ON (meds) state There was also an improvement in movement speed post AAC vs. pre AAC This research suggests that AAC may be used to improve tremors and bradykinesia during the OFF period of medication |
Progressive resistance training (PRT) The PRT group completed an orientation session, 1-RM testing, and then a 10 week PRT program. Biomechanical analysis of gait initiation was performed pre- and post-intervention and included displacement of COP, initial stride length, and velocity. (Hass, 2012) | RCT Inclusion : Idiopathic PD, Modified Hoehn & Yahr stage 1-3 with ability to ambulate w/o assistance. All participants were on stable doses of anti-Parkinson meds, which remained consistent throughout testing N=18, control (7M, 2F) & PRT (7M, 2F) | Significant Group x Time interaction for stride velocity (F = 4.324, P = 0.05) PRT group had significant 11% increase in stride velocity (PRE: 0.71 +/- 0.17m/s and POST: 0.79 +/- 0.20 m/s, p = 0.04) PRT may be an effective treatment to improve gait initiation performance in people with Parkinson's. |
Brunnstrom Movement Therapy (BMT) vs Motor Relearning Program (MRP): 30 post-stroke patients: Group A received BMT while Group B received MRP. Both groups also received conventional occupational therapy for UE and LE. Interventions were for three days per week for four weeks lasting 1 hr each. (Pandian, 2012) | Randomized Controlled Trial Inclusion: Subjects post-stroke (n=30); ages 35-60 yrs, in stage 3 of Brunnstrom recovery stage of the hand, divided into two groups: Group A (10M 5F) B (14M 1F) Exclusion: Subjects with cerebellar lesions, subluxated shoulder, any contracture or deformity of UE and no sitting balance. BMT involves using reflexes to develop movement behaviors through sensory input in order to retrain movement and retrain behavior. The outcome measures used in the study were BRS-H and the Fugl-Meyer assessment. The Fugl-Meyer Hand and Wrist (FMA-WH) was used in this study to evaluate aspects of movement, reflexes, coordination, and speed. | Statistically significant differences between the groups at post-intervention assessment for FMA-VIII and FMA-WH (p =Z 0.004e0.037) favoring BMT. BRS-H and FMA-VII and IX were not found to be significantly different between the groups at post-intervention. There was a significant difference of median score of 2 for FMA-VIII favoring BMT. There was significant mean difference of 4.34 for FMA-WH between the groups post-intervention favoring BMT. Both BMT and MRP protocols were effective in enhancing the motor recovery of hand in chronic stroke patients. BMT was better than MRP for the wrist and hand recovery, particularly the mass finger flexion, extension and grasp. |
| EMG, E-Stim & Other Modalities |
Myoelectric computer interface (MCI) was used to map electromyographic (EMG) signals from up to 5 isometric muscle activations in order to move a cursor into a target area. Healthy subjects: 3 sessions up to one week apart comprised of 8-target task (pre-training) for 10 minutes, training task for 20 minutes and 8-target task (post-training) Subjects with stroke: 3 sessions a week for 6 weeks comprised of pre-training task for 10 minutes, training task for 30 minutes, and post-training task for 10 minutes (Wright, 2014) | Pilot Study Healthy subjects (n=5) age:23-27 years and individuals with stroke (n=5), age: 50-58, 1.5-25 years post-unilateral ischemic stroke Exhibited co-activation of anterior deltoid and biceps Fugl-Meyer Motor Assessment upper extremity portion score: 12-40 | Decoupling: from pre-training phase of session 1 to post-training phase of session 3 the correlation of biceps and brachioradialis muscles in healthy participants decreased significantly (p=0.046) Decoupling: from the 1st session early training to last session late training, the correlation between anterior deltoid and biceps muscles in stroke survivors decreased significantly (p=0.005) Task performance: Stroke survivors improved significantly from the 1st session early training to last session late training in success rate (p=0.03), and time to target (p=0.01). Fugl-Meyer Motor Assessment – Upper Extremity: improvement in 3 out of 5 stroke survivors by 3 points each |
Non-invasive brain computer interface (BCI) was used to trigger functional electrical stimulation (FES) for isolated index finger extension through attempted and imagined finger movement. ~45 minute sessions 3 times a week for 3 weeks During the 3 weeks of training the participant also received 3 visits averaging 1.6 hours each for volitional functional task movements, 30 minutes of surface FES for mass whole-hand opening, and 30 minutes of surface FES for thumb abduction. (Daly, 2009) | Case study Individual was 10 months post-stroke, and age 43 years Unable to perform isolated digit movement on involved hand Initially, the participant exhibited abnormal synergy with effort of MCP hyperextension, and IP and DIP flexion of all digits in her involved hand. | Participant able to activate FES and visual feedback with brain signal 97% of the time during attempted movement, and 83% of the time during imagined movement in session 1 Motor Recovery: After 3-week training period, participant was able to volitionally control 26 degrees of isolated index finger extension at the MC joint. The participant's ability to deactivate brain signal (relaxation) improved from 63% in session 1 to >80% by session 6. |
Participants performed task-specific exercises, modified over time due to patient improvement, while using FES on the finger and thumb flexors and extensors, enabling opening and closing of the hand. The FES aided with movement initiation and completion. They began with 10 min. sessions, repeated four times daily, with the last two being FES only. The duration of the FES session was increased 5 min. daily over 11 days. Outcome measures were the modified Fugl-Meyer, Box & Blocks (B&B), and Jebsen-Taylor light object lift. (Alon, 2008) | Non-blinded, block-RCT Post CVA survivors Comparing FES and exercise with exercise only in helping regain task-specific movement in sub-acute CVA patients (n = 26); 13 in FES experimental group, 13 in control group Unilateral ischemic stroke post CVA 2 to 4 weeks Paralysis / paresis of UE Fugl-Meyer score 2-10 Age range: 20-90 yo 60&00B0; finger flexion/extension response to stimulation MMSE score > 21 | Experimental FES group exhibited significant improvement in functional impairment (mF-M score of 24.2 ± 13.7 patients (experimental) vs. 14.5 ± 10.3 patients (control)) Significant difference not reached in B&B (Box & Blocks) due to sample size. However, more improvements made in experimental group: 8/13 transferred ≥ 10 blocks (experimental) 3/13 transferred 5 blocks (control) No statistically significant difference in Jebsen-Taylor light object lift FES appears to improve volitional control and outcomes as noted in modified Fugl-Meyer results above Statistically significant results may be obtained by increasing sample size and increasing treatment period |
Surface electrodes were placed over extensor carpi radialis & extensor digitorum communis of the affected arm. EMG biofeedback (group 1) or placebo EMG biofeedback (group 2) was administered (20min, 5x/wk, 20 days). Both groups received an exercise program according to the Brunnstom's neurophysiologic approach (45min/day for 20 treatments). (Armagan, 2003) | A clinical, prospective, randomized, placebo-Controlled Study Patients with onset of hemiparesis of a vascular origin (n=27); 3-6mo post onset; avg. age=57; divided to:14 in experimental group & 13 in control group Brunnstrom Stage 2 or 3 | In both groups a significant improvement was observed in: Brunnstrom's stages of motor recovery, up to stage 4 (group 1:p<0.001; group 2:p<0.01) Performance of drinking from a glass: able to perform entire movement without fluid in glass (group 1:p<0.01; group 2:p<0.01) Both groups showed significant improvement in active wrist ext., but group 1 (p<0.001) was statistically more significant than group 2 (p<0.05). |
Stroke electromyogram (EMG)-triggered neuromuscular stimulation on arm and hand function. (Bolton, 2004) | Meta-analysis of effect of treatment of 2 groups; CVA treatment group (n=47) and control group (n=39) Computer searches of PubMed and Cochran databases included 5 EMG-triggered neuromuscular stimulation studies based on randomization, double blind, and dropouts for analysis. | Outcome measures focused on arm and hand motor capability functions. Analysis found a significant overall mean effect size δ=0.82, S.D. =0.59, supporting EMG-triggered neuromuscular stimulation as an effective post-stroke protocol, although only 5 studies were included and 15 were calculated to be necessary for fail-safe conclusions. |
Both groups: sessions ~60 min, 3 days/wk, for 2 wks Group 1: surface electrodes were placed on extensor communis digitorum & extensor carpi ulnaris to assist full ROM (1s ramp up, 5 s of biphasic stimulation at 50Hz, 1s ramp down, E-stim ranged from 14-29mA. Group 2: PROM, stretching, & attempted AROM was administered. (Cauraugh, 2000) | Randomized clinical study Subjects 3.49 yrs after stroke (n=11); avg. age=61.64; divided to 2 groups: experimental group (n=7) & control group (n-4) ≤75% motor recovery & able to voluntarily ext. wrist 20&00B0; | Experimental group: Had a 129% gain in UE control as seen from the Box & Block test (F(1,10)=5.84, p<0.05) Improvement in sustained muscle contraction (F(1,44)=2.27, p,0.08) |
3 groups: (1) coupled protocol of EMG-triggered stimulation and bilateral movement (n=10); (2) EMG-triggered stimulation and unilateral movement (n=10); or (3) control (n=5). All participants completed 6 hours of rehabilitation during a 2-week period according to group assignments. (Cauraugh, 2002) | | The coupled group completed the Box and Block Test (PICT) significantly faster. Median reaction time also improved to a greater degree in the coupled group as well as consistency of muscle contraction of impaired limb while moving the less impaired limb as measured by EMG. |
Neuroprosthesis Bioness H-200 & task training: Pt received stretching, stability exercises, & task-specific training incorporating an electrical stimulation neuroprosthesis for 3 hr/day, 5 days/wk for 20 days. 11KHz, 36 bursts/sec, interrupted-pulse, 7 sec on: 7 sec off, 2 sec ramp up time (Dunning, 2008) | | Fugl-Meyer score increased 14.8% ARAT score increased 12.5% AMAT functional ability scale score increased 3.9% Box & block test score increased 25% MAL score increased to 1.17 (using the affected arm independently) Patient reported increase in independence of ADL's |
This was a preliminary study involving transcranial direct current stimulation (tDCS) and its effects on the tibialis anterior muscle (TA) isometrically via ballistic EMG control and proportional EMG control of FES. The focus was on delays of initiation and termination of muscle activity with this system when targeting the motor cortex (M1) or the cerebellum. (Dutta, 2014) | | The termination of muscle activity was significantly slower than initiation during all baseline trials. After initiation, cerebellar tDCS increased delay in initiation of muscle activity while M1 decreased it. M1 tDCS increased delay in termination while cerebellar tDCS showed a trend of decreasing it. These results will aide in placement of sensors during future research of patients with poor motor control. |
All subjects received two 30min. sessions/day of wrist strengthening exercises with EMG-stim (experimental) or without (control) for the duration of their rehabilitation stay. EMG-stim (0.2msec width, 0-60mA,biphasic square wave pulse at 20-100Hz, duty cycle of 5sec on: 5sec off, EMG detector sensitivity 5-80μV. (Francisco, 1998) | Pilot randomized, single-blinded clinical trial Individuals with first-time stroke within 6wks of stroke onset (n=9); avg. age=60.3; Volitional wrist ext in synergy or isolation w/ MMT ≤3/5 2 groups: experimental group (n-4) & control group (n=5) | |
EMG-stim adjunct w/ CIMT: Pt. received CIMT (6 hrs/day) with EMG-stim (3 of the 6 hrs) for 2 weeks. Functional task practice with progressive task complexity was implemented in therapy w/ EMG-stim facilitating activities involving wrist ext, grasp, & release. (Fritz, 2005) | | Improvements in: Fugl-Meyer (pretest-97 to posttest-102) specifically the flexor synergy (shoulder retraction/ER) & wrist stability subcomponent WMFT timed scores (pretest-20s to posttest-5s) & functional rating (pretest-2.5 to posttest-2.73) AAUT showed an increase in spontaneous use (pretest-0.25 to posttest-1.1) & quality of use (pretest-0.6 to posttest-1.6) MAL amount score increased to using his affected hand sometimes (pretest-0.85 to posttest-1.76) & quality score improved, but still moved slowly & required assistance from unaffected arm (pretest-1.02 to posttest-1.70) SIS perceived level of recovery from 40% to 65% |
3 groups receiving standard rehabilitation (SR) with FES or SR with placebo stimulation or SR only (control). SR included 1 hour PT 5 days/wk for 3 weeks. FES was applied 30 min/day to quads, hams, tib anterior, and med gastroc during gait. (Yan, 2005) | | There was a significant reduction in the percentage composite spasticity score, a significant improvement in voluntary ankle dorsiflexion torque, accompanied by an increase in agonist electromyogram and a reduction in electromyogram co-contraction ratio in the FES group, comparatively (p<0.05). The number of days before able to walk was also significantly less for the FES group. All subjects in the FES group were able to walk after treatment, and 84.6% of them returned home, in comparison with the placebo (53.3%) and control (46.2%, p<0.05) groups. |
FES was performed on 3 chronic stroke patients in order to cause their paretic hand extensor muscles to contract; resulting in opening of the hand. Patients controlled the intensity of the electrical stimulation. Patients used e-stim on impaired hand (through volitional opening of unimpaired hand) to perform active, repetitive hand-opening exercises for 2 hrs / day at home; along with functional tasks 1.5 hrs twice / wk in lab. (Knutson, 2007) | | Intervention group: max voluntary finger extension increased (sustained at 1 mos follow-up) in 2 patients. Max voluntary isometric finger extension moment, finger-movement control, and BBT score increased (sustained at 1 mos follow-up) in all 3 subjects. However, the improvements generally declined at 3 mos. Measurement tools: Max voluntary finger extension, max voluntary isometric finger extension moment, finger movement control, and box & block test (BBT) score. |
A six-month study of the Handmaster hybrid orthosis FES in spastic hemiparesis. The Handmaster hybrid orthosis FES was used for motor stimulation. The system includes 5 electrodes that stimulated finger extensors (extensor digitorum communis and extensor pollicis brevis) and flexors (flexor digitorum sublimis, flexor pollicis longus, and thenars). The stim provided active movement throughout available ROM. Daily stimulation 2x/day started at 30 minutes and was progressed to several hours/day (Weingarden, 1998) | | |
This study addressed the issue of TS intervention in the facilitation of functional outcomes. Thermal agent was made by general hot (~75°C) or cold (<0°C) pack wrapped with 2 towels, which buffered the thermal conduction. The thermal agent was placed over the region of the hand and wrist. A thermal couple was placed in between the hand and thermal agent to measure the skin temperature. A session of TS, which contained 2 alternate cycles of heating and cooling stimulation, was performed once daily. The facilitative program contained 5 sessions per week and lasted for 6 weeks. (Chen, 2005) | Single Blind Randomized Trial Subjects with stroke (n=29), randomized to 15 in treatment group and 14 in control; Six measures, including Brunnstrom stage, modified motor assessment scale, grasping strength, angles of wrist extension and flexion, sensation by monofilament, and muscle tone by modified Ashworth scale, were performed weekly to evaluate sensory and motor functional outcomes. | The performance of Brunnstrom stage and wrist extension and sensation were improved significantly after TS intervention. Recovery rates of 6 measures after TS were significantly higher than those of the control, except for grasping. Similar muscle tones were found in both groups. |
Biofeedback for prevention of synkinesis Intervention focus was on prevention of eye closing while performing mouth movements. 3 specific movements were of focus: pursing lips, baring teeth and puffing check. A mirror was used for biofeedback. Sessions: Patients performed 30 minutes of home exercises for 10 months. (Nakamura, 2003) | Design: Prospective randomized design. Controls received no treatment. Subjects with complete facial palsy (n=27), age 17-67. The majority had Bell's palsy or herpes zoster oticus. Inclusion criteria: complete facial palsy with no response to electrical stimulation. Video analysis was performed to determine amount of eye closure during mouth movements. A ratio was calculated based on the percentage of eye opening of the normal side. | Results: significantly increased eye opening in experimental group than control group with all 3 categories tested. Using Mann-Whitney: Pursing lips (p=0.0001,), baring teeth (p=0.0006) and puffing cheeks (p = 0.0034). |
| Robotic Therapy |
Post-stroke patients: 45 minutes (at least 65 turns per session) of intense robot-mediated treatment 5 days a week for 6 weeks.) If the target could not be reached by the patient, an assisting force was provided by the robot. During the 1st session and every two weeks thereafter patients participated in an additional session with no assisting force where EMG signals of the upper arm and shoulder muscles were recorded. Healthy subjects: 5 sessions at varied cadence (80, 60, 40, 30, and 24) consisting of a 10-minute warm-up followed by 5 robot-mediated treatment turns with no assisting force. The first turn at the cadence most similar to the patients at discharge was used for analysis. (Tropea, 2013) | Pilot study Subjects included sub-acute post-stroke patients (n=6), age 66-82 years old, and healthy subjects (n=10), age 64-80 years old | Voluntary isolated movement and accuracy significantly improved in patients from admission to discharge as documented by a 72.7% increase in the Fugl-Meyer Assessment score (p= 0.049) Modified Ashworth Scale: patients spasticity tended to decrease with treatment (p=0.113) Improved robotic related metrics in patients: reduction in Normalized Path Length (increased accuracy) (p=0.24), significant increase in smoothness of movement (p<0.01), reduction of absolute hand path error (p=0.39) and significant decrease in the number of peaks (reduction in deceleration and acceleration periods) (p=0.02). |
Training consisted of 4 upper extremity virtual reality gaming simulations using adaptive robots that incorporated upper arm, wrist, and hand movements. 2 hour sessions progressing to 3 hour sessions by increments of 15 minutes with equal time spent on each of the 4 simulations for eight days The 4 simulations included: Plasma Pong© (shoulder flexion/extension, and rapid finger extension), Hummingbird Hunt (arm transport, grasp, hand-shaping, and pincer grip), Hammer Task (repetitive finger flexion/extension, and 3-D reaching), and Virtual Piano. (Merians, 2011) | Clinical Trail Patients with chronic stroke (n=12) at 9 months - 15 years post-stroke, and mean age: 55 ±14 years Subjects had to have wrist and finger extension of at least 10 degrees | Jebsen Test of Hand Function: 24 second decrease in time to complete (the scores improved only in the hemiparietic hand after the 8 session of training compared to the subjects uninvolved hand, and nine age-matched healthy controls). Wolf Motor Function test: clinically important mean decrease of 16 seconds for the group, and every subject exceeded the minimal detectable change (4.36 seconds) indicating a true change. Fractionation of subjects without haptic assistance from CyberGrasp improved significantly with a 39% change Motor learning: The time to complete the task improved significantly with a change of 19% without any change in accuracy. Hammer Task: Time per cylinder (p=0.005), arm endpoint path length (p=0.003), arm endpoint smoothness (p=0.05), and arm endpoint deviation (p=0.002) improved significantly. Peak MPJ extension improved but not significantly (p=0.16). These results reveal improved proximal stability of the arm. Virtual Piano Trainer: Significant improvement was noted in finger fractionation (p=0.044), and time to press each key (p=0.04). No significant change was noted in accuracy (p=0.48). |
GENTLE/s robot-mediated therapy (RMT): In the robot-mediated phase (RMP), subjects practiced 3 functional exercises (subject specific) w/ haptic & visual feedback from the system. In the sling suspension phase (SSP), subjects practiced 3 single-plane exercises. Each functional exercise was practiced 10 min each for a total of 30 min. Each treatment phase was 3 wks. (Coote, 2008) | Series of single-case studies, randomized multiple baseline design w/ ABC or ACB order Sample convenience with residual arm dysfunction following stroke Group1 (ABC): mean age 66, 15.9 mo post-stroke, (n= 10) Group 2 (ACB): mean age 69.1, 28.1 mo post-stroke, (n=10) | Fugl-Meyer: RMP (in 7 subjects) > baseline & (SSP) Mean increase of 10.62 patients ABC: Mean difference between RMT & SSP was 0.197; CI -0.055-0.449, p=0.111 ACB: Mean difference between RMT & SSP was 0.048, CI -0.25-0.154, p=0.604 Suggests a trend for a significantly higher slope in the RMT AROM: shoulder flexion: mean increase of 6.93&00B0; ABC: Mean difference between RMT & SSP was 0.179, CI -0.020-0.378, p=0.072 ACB: Mean difference between RMT & SSP was 0.188, CI -0.4068-0.084 Suggesting a trend for a statistically higher mean slope in the RMT Motor Assessment Scale: Mean increase of 4.41 patients ABC: Mean difference between RMT & SSP was 0.039, CI -0.111-0.189, p=0.571 ACB: Mean difference between RMT & SSP was 0.143, CI -0.2535-0.0325, p=0.017 Suggesting a significantly higher slope in the RMT Modified Ashworth Scale: RMT: 6 subjects decreased their score, with a Z value -2.449 & (p= 0.014) |
Patients received 45 minutes of conventional therapy daily. Robot group received 15 minutes daily with the arm trainer for 3 weeks; the one degree of freedom trainer enabled the bilateral passive and active practice of forearm pronation/supination and wrist flexion/extension; impedance control guaranteed a smooth movement. (Hesse, 2003) | Consecutive sample Patients with chronic hemiparesis (n=12), age 36-70, minimum stroke interval 6 months Could maximally protract the affected shoulder, hold the extended arm, or slightly flex and extend the elbow. | Although there was no control group to compare, 8 subjects noticed a reduction in spasticity, an ease of hand hygiene, and pain relief. MAS decline slightly but significantly. Rivermead Motor Assessment (RMA) score before therapy was 2.0 (1–2) and 2.0 (1–3.75) after therapy, therefore no significant improvement was noted. |
Study compared a computerized arm trainer (AT), allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle, and electromyography-initiated electrical stimulation (ES) of the paretic wrist extensor. (Hesse, 2005) | Single Blinded Randomized Trial Patients with severely effected subacute stroke (n=44), divided to two groups: 22 patients used AT with pronation/ supination and wrist flexion/extension 22 patients had ES facilitation wrist extension. | The AT group had a higher Barthel Index score at baseline, but the groups were otherwise homogenous. As expected, FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group. The initial Barthel Index score had no influence. In the robot AT group, FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group. MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group. Muscle tone remained unchanged, and no side effects occurred. |
This preliminary study explored change in patient-reported, health-related quality of life associated with robotic-assisted therapy combined with reduced therapist-supervised training. Sixty hours of therapist-supervised repetitive task practice (RTP) was compared with 30 hours of RTP combined with 30 hours of robotic-assisted therapy. (Kutner, 2010) | Randomized Clinical Trial Individuals who were 3-9 months post-stroke (n=17) Participants completed the Stroke Impact Scale (SIS) at baseline, immediately postintervention, and 2 months postintervention. Change in SIS score domains was assessed in a mixed model analysis. | The combined therapy group had a greater increase in rating of mood from preintervention to postintervention, and the RTP-only group had a greater increase in rating of social participation from preintervention to follow-up. Both groups had statistically significant improvement in activities of daily living and instrumental activities of daily living scores from preintervention to postintervention. Both groups reported significant improvement in hand function postintervention and at follow-up, and the magnitude of these changes suggested clinical significance. The combined therapy group had significant improvements in stroke recovery rating post-intervention and at follow-up, which appeared clinically significant; this also was true for stroke recovery rating from pre-intervention to follow-up in the RTP-only group. |
Robotic-assisted rehab was conducted on post-stroke patients with hemiparetic and hemiplegic UE. Patients included those with acute stroke (less than or equal to 1 week post-CVA). (Masiero et al, 2007) | Single-blind randomized CT 8 mo follow-up Patients post-stroke with hemiplegia (n=35), divided to two groups: Intervention group (n=17) received conventional PT in addition to robotic training (intervention group) for 4 hrs / wk for 5 wks; Control group (n=18) received conv. PT in addition to robotic training for 30 min / wk twice a wk for 5 wks on unimpaired limb | Intervention group: significant gains in motor impairment & functional recovery of involved UE. Gains in function were sustained at 3 and 8 mo follow-up. However, no significant improvements noted in the Modified Ashworth Scale (MAS) and the Trunk Control Test (TCT). Measurement tools: Fugl-Meyer Assessment (FMA) of UE function, Medical Research Council score (MRC), FIM, TCT, MAS. |
Intervention: lateral postural assist with step initiation. Robotic assistance to increase lateral shift via a motor driven system with a belt placed around pelvis to apply assist during step initiation. *Baseline analysis (tracings of foot placement on force platform ad kinematic video analysis) was conducted at maximal walking speed unassisted. (Mille, 2006) | Design: Experimental design, non-controlled. Total subjects (n=16), with 8 patients with PD and 8 age and gender matched controls Inclusion Criteria Experimental group: idiopathic PD stage 1.5 to 3 on Hoehn & Yahr. Testing was performed 12 hours off medications. Controls were within 3 years of matched PD subjects. | PD subjects had longer anticipatory postural adjustments (APA) with and without assistance (p<0.01) and had increased initial step duration (p=0.027) than controls. With assistance APA for controls was 63-108 msec. and 93-116 msec. for PD group. Using the robotic assistance both groups had decreased APA (p<0.001). PD group showed improvement of step initiation. With assist step initiation occurred 77 to 97 msec. earlier in PD group and 41-97 msec. earlier in controls. Conclusion was that lateral weight applied externally improves step initiation. |
A passive exercise program was performed on the right UE using a robotic arm. Nerve conduction study was conducted pre and post treatment. Max onset and peak amplitudes of Hoffman reflex (Hmax) and motor response (Mmax) wave were recorded. (Patel, 2006) | | Intervention group: immediately post- passive exercise there were no appreciable variation in the Hmax, Mmax, or Hmax/Mmax ratio as compared with pre-exercise recordings. Study suggests peripheral proprioceptive input with passive exercise using robotic arm does not have a significant influence on motor neuron excitability of affected UE in stroke patients. |
Participant completed approximately 48 hours (each day hrs using robotic device and 2hr of RTP) of intervention split evenly between the hand Mantor (robotic device) and repetitive task therapy for 3 weeks. The robotic device was placed on different modes throughout the therapy session: Motor Control Up mode and antispasmodic modes. RTP consisted of feeding tasks, ironing, sweeping, turning faucets on and off, using a steering wheel, carrying a laundry basket, etc. (Rosenstein, 2008) | Single participant study 32 year old female (n=1) 11 months post stroke Did not use affected UE for functional tasks Affected arm went into a flexion synergy when attempting to do tasks No isolated finger movements Modified Ashworth scale of 1+ for the wrist flexors | Fugl-Meyer upper-extremity motor pretest score was 23/66; on the posttest score was 26/66 Modified Ashworth Scale of 1 in elbow flexor tone, wrist flexors did not change with intervention Wolf motor function test- improvements in these areas of the test: forearm to table (difference of .13), extend elbow side (difference of 9.95), reach and retrieve (difference of .23), and lifting a basket (differences not available) AROM increased carpometacarpal thumb abduction from -20 to 50 degrees, wrist extension (increased from -50 to 15 degrees), forearm Supination (increased from 10-65 degrees), and shoulder flexion (increased from 0 to 35 degrees) Grasping force increased as well |
Robot assisted repetitive UE task of circle drawing with study focus on possibility of changing synergy patterns. 18 one-hour sessions. Device was used to train and analyze paretic arm movements. (Dipietro, 2007) | Non-randomized and not blinded Patients with single, unilateral stroke (n=117), at least 6 months post injury, able to follow instructions and a MMSE of 22 strength of 1-3/5 in the UE MIT-MAMNUS and InMotion2 were used Fugel-Myer scoring used to assess baseline, during treatment and final improvements | Improved circle drawing noted post training, use of metrics to determine initial and post training comparison Robotic device also analyzed arm movements determining improvement in shoulder and elbow isolated movements Authors propose that improvement in isolated UE movements are indicative of augmentation of synergies not extinction of them. Study limitations of no control group and no comparison of treatment protocols. |
The aim of the study was to investigate the efficacy of combined passive stretching and active movement training with motivating games using a portable rehabilitation robot in 12 children with CP Each session consisted of 20 minutes of passive stretching, 30 minutes of active movement, and 10 minutes of passive stretching. (Wu, 2011) | Design: 12 children (6 girls, 6 boys) with mild to moderate spastic CP participated in robotic rehabilitation 3 times a week for 6 weeks. 6 had diplegia and 6 had hemiplegia. Outcomes were measured before and after the 6 week intervention Outcomes were: Modified Ashworth Scale, Modified Tardieu Scale, Pediatric Balance Scale, and Selective Control Assessment of the LE, 6 minute walk, and TUG. Biomechanical measures were PROM, AROM, and muscle strength | A decrease in MAS score was seen at the ankle. SCALE scores increased significantly (p=.003). Significant improvements were at the ankle, and significant improvements in selective motor control of the hip and foot were also observed. All patients improved in balance and patients walked further during the 6MWT. TUG scores did not change. Significant increases in dorsiflexion: PROM, AROM, and muscle strength The results suggest that passive stretching combined with biofeedback games may benefit children with CP with impaired ankle function The robotic encouraged movement immediately after flexibility and increased the chances of children with CP of experiencing demanding movement control activities, which helped improve their motor control ability. |
Bilateral robot-assisted arm therapy sequenced with constraint-induced therapy (RT + mCIT) compared to bilateral robot-assisted arm therapy (RT) alone. Both groups averaged 90-105 minutes per day, 5 days per week, for 4 consecutive weeks, with robot-assisted arm therapy using Bi-Manu-Track. Both groups were given RT only for the first 2 weeks of the study. RT + mCIT group was given mCIT for the second 2 weeks of the study (Mitt worn on the unaffected hand 6hrs/day). The level of challenge during functional task training during mCIT was adjusted according to patient skill. (Hsieh, 2016) | Single-blinded randomized controlled trial Individuals with chronic stroke, >6mo s/p stroke, (n=34) with 17 in each group, MMSE > or = 22, FMA score of 20-50 No significant differences between group in baseline measures Outcome measures: kinematic variables in a task of reaching to press a desk bell, Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living All outcome measures were taken before and after intervention | Peak velocity of movement was significantly smaller in the RT &mCIT group Max shoulder abduction when performing task of ringing desk bell was significantly smaller in the RT & mCIT group than in RT group Max elbow extension when performing task of ringing desk bell was significantly greater in the RT & mCIT than in RT group RT & mCIT had significant improvements in the Wolf Motor Function Test-Functional Ability Score(p=.01) and Nottingham Extended Activities of Daily Living(p=.02) |
| Body Weight Supported Treadmill (BWS)/Treadmill Training |
Research was conducted to determine whether treadmill walking with body weight support was effective at establishing independent walking more often and earlier than current physiotherapy intervention for nonambulatory stroke patients. The experimental group undertook up to 30 minutes per day of treadmill walking with body weight support via an overhead harness whereas the control group undertook up to 30 minutes of overground walking. The primary outcome was the proportion of participants achieving independent walking within 6 months. (Ada, 2010) | RCT Patients with hemiparesis or hemiplegia from stroke, and nonambulatory; 55 women and 71 men. The mean age was 71 (sd 9) Mean number of days after stroke was 17 (sd 7) | Kaplan–Meier estimates of the proportion of experimental participants who achieved independent walking were 37% compared with 26% of the control group at 1 month, 66% compared with 55% at 2 months, and 71% compared with 60% at 6 months (p=0.13). The experimental group walked 2 weeks earlier, with a median time to independent walking of 5 weeks compared to 7 weeks for the control group. In addition, 14% (95% CI, -1–28) more of the experimental group were discharged home. |
Effect of treadmill (TM) walking on gait variability. Compared stride to stride variations, stride time variations and swing time during TM walking to overground walking with a 4 wheeled walker (to eliminate possibility that changes were due to holding hand rails). TM speed was set based on comfortable on ground walking speed. A safety harness was used with TM walking with full weight bearing. A system was used to analysis gait characteristics that utilized sensors in specialized shoes. (Frenkel-Toledo, 2005) | Controlled clinical study Subjects included independent ambulators with PD (n=36), Hoehn & Yahr stage 2-2.5; and 30 matched controls. | PD patients had greater variability of gait measures with unaided ground walking with and without the walker. Use of TM reduced variability and improved gait stability. TM walking reduced stride time variations and swing time variability in both groups (p=<0.05). TM decreased swing time on only the PD group. |
BWS treadmill provides controlled reduction of weight bearing and provides postural support and promotes LE coordination. BWS ambulation training was 2-3x/wk x6-7 weeks with each session consisting of 3 bouts of BWS ambulation on the treadmill and 1 bout of BWS ambulation over ground (Miller, 2005) | | |
Patients were randomly assigned to varying sequences of the following interventions over 4 consecutive days: structured speed-dependent treadmill training (STT), limited progressive treadmill training (LTT), conventional gait training (CGT), and a control intervention (resting 30 minutes in a comfortable sitting position. (Pohl, 2003) | Randomized, multiple intervention crossover pilot study Patients with early PD (n=17); Hoehn and Yahr stages I through III, with gait disturbances | Basic gait parameters: (over ground walking speed and stride length at self-adapted speed and vertical ground reaction forces. STT and LTT improved all basic gait parameters and ↓ double support. No changes were found after CGT and the control intervention (p<.05). Significantly higher gains were observed in all basic gait parameters after STT and LTT when compared with CGT and the control intervention (p<.05). No significant differences in gains were observed between STT and LTT, or between CGT and the control intervention, in all gait parameters. |
Treadmill exercise for stroke patients to reduce spastic reflexes and hamstring strength. Structured as a modified low intensity cardiac rehabilitation program. Walking with hand rail support on TM. Sessions: 3 x/wk for 3 months. Initial intensity was restricted to 40% heart rate reserve (HHR) and gradually increased to 60 to 70% of HHR. Isokinetic testing was used to assess amount of passive, reflexive torque and concentric/eccentric volitional torque produced by hamstrings. (Smith, 1999) | Pilot/feasibility study Subjects with stroke (n=14), all independent home ambulators, had plateaued with conventional therapy, with residual mild to moderate hemiparesis and gait deviations | Spastic reflexes: passive torque generation reduced by 11% (p<0.027) Concentric torque: affected limb increased 50% (p<0.01) Unaffected increased 30% p<0.01) Eccentric torque: affected increased 21% (p<0.01) Unaffected increased 22% (p<0.01) |
BWS treadmill was used for gait training, balance perturbation, and step training 1 ½ hours x3days/week x8 weeks (Suteerawattananon, 2002) | | After training the patient's falls decreased Timed foam standing test improved by 7 seconds FRT increased 3.63cm Gait speed increased, timed turns decreased, and timed 5 steps decreased There was no change in the Get Up & Go Test |
This study compared robotic rehabilitation using error enhancement to facilitate motor learning to passive treatment for patients post-stroke. This study incorporated a reaching task facilitated with a robotic arm to enhance errors by the participant. The movement task was performed with a mouse and computer monitor The participant would start with the cursor on a starting point and then move to an end point at their own pace Velocity, tracking, and variability of movement were tested as outcomes. (Givon-Mayo, 2014) | Experimental design All participants post-stroke, volunteered for treatment (n = 7) with 6 males; Mean age = 59. Inclusion: All participants had to be able to understand simple commands and perform some reaching movements with affected arm | Half of experimental group showed higher improvement than control group on MAS scale (27% and 40% improvement in total score). No significant improvements were found between pre- and post-test scores on the Fugl-Meyer assessment in either experimental or control groups. Post-test graphical results show that all subjects within the experimental group showed decreased variability in path trajectory towards the end goal. Post-test velocity stayed the same in the experimental groups whereas the control group velocity decreased (14.16-8.69 cm/second, p < 0.05) |
Partial body weight support treadmill training to improve gross motor function. BWSTT Group (n =15) with experimental intervention of partial body weight supported treadmill training with the speed and degree of inclination determined by the Bruce Protocol Control Group (n =15) received conventional physical therapy neuro developmental training The Bruce Protocol was progressed until the child reached their maximum capability, with most children reaching stage five with inclination of 3-5%. (Malarvizhi, 2016) | Experimental design | Significant improvements were found between the pre and post test measurements for participants in both Groups with a mean (BWSTT- 72.0040; 0.092), (Control- 66.9187; 0.078) and (p < 0.05) Independent t-test showed a highly significant improvement in GMFM and 10MWT in BWSTT group (p < .05) |
| Repetitive Movement Practice |
The study compared using practice with simple movement tasks and complex movement tasks in the treatment of patients with neurological disorders. The study compared reaction times and movement time during right arm reaching tasks initially to the times obtained after training with repetitive practice. The movement tasks included one simple movement and one complex movement (Behrman, 2000) | | Practice was found to significantly increase reaction time (initiation) and (speed of movement. Reaction time for the simple movement was significantly lower than the reaction time for the complex movement. RTs for simple and complex movements decreased significantly from pretest values. Movement time decreased by an average of 33 seconds in subjects with PD following exercise. |
Treatment for upper and lower extremity bradykinesia and hypokinesia. "Training BIG" is a protocol that consists of practicing large amplitude movements of the whole body and simultaneously focusing on the "movement bigness". Multiple repetitions, and various intensity and complexity of tasks were used. Half of session was whole body maximal amplitude drills, static BIG stretches (i.e. reaching/twisting to side in standing and sitting for 10 seconds) and repetitive multidirectional movements. For feedback they were told to pay attention to how big the movements felt and were asked "how big did that feel?. The other half of the session used the concepts from drills. Sessions were 4x/wk x 4 wks, 1 hour each. The study examined whether generalized training with large amplitude movements of the head, neck, trunk and limbs had an effect on amplitude and speed of walking and reaching. Data collected was reaching for weighted cups at various distances, point to point reaching and gait analysis stride length velocity cadence (Farley, 2005) | Design: Blinded examiners. All treatment by one therapist who did not perform any data collection. Matched control group of PD with no treatment. Subjects with PD, stage I – III (n=18) Inclusion criteria: Subjects were required to be on a stable medication regimen and not participate in outside therapy /exercise. | Reaching: 14% increase velocity at 2 largest distances in experimental group and 5% in control group (p=.004). Speed increased 16% at longest reach distance only and 5% in control (p=0.009). Gait: 12% increase (p= .01) in preferred gait velocity in experimental group, 4% increase in control group. Stride length increased in experimental group (p<0.004), but no change in cadence (p=0.91). |
Task specific training with a trunk restraint performing supervised home program 3x's wk for 5 weeks. (Michaelson, 2006) | Double-blind, randomized controlled trial Patients with chronic hemiparesis, non-traumatic stroke (n=30); mean 17±10mos post stroke; mean age 46±12year 2 groups: wearing trunk restraint and not wearing trunk restraint | Both groups improved from baseline Both groups improved elbow strength (p<.002), Box and Block Test (BBT) time (p<.01), peak velocity (p<.002), trajectory smoothness (p<.001), and straightness (p<.01) Using the Fugl-Meyer Test (FM), treatment group had greater decreases in impairment Using the Upper Extremity Performance Test (TEMPA), the treatment group had greater improvements in function (p<.05) Treatment group's elbow extension significantly improved (5.9° posttest, 2.9° at 1-month follow up) (p<.02) |
Inclusion criteria required bilateral training protocols involving either functional tasks or repetitive arm movements alone or in combination with auxiliary sensory feedback (Stewart, 2006) | Meta-analysis referencing lists of bilateral motor recovery articles as well as PubMed and Cochrane databases Included 11 stroke rehabilitation studies for analysis of bilateral training for hemiparetic patients | Each study had one of three common arm and hand functional outcome measures: Fugl-Meyer, Box and Block, and kinematic performance. Analysis revealed an overall effect size (ES = 0.732, S.D. = 0.13) indicating that bilateral movement training was beneficial to improve motor recovery post-stroke. A fail-safe analysis indicated that 48 null effects would be necessary to lower the mean effect size to an insignificant level. |
Each participant was requested to hold a stylus pen with the right hand and perform a rapid linear aiming arm movement between the "home" and target positions on the surface of the digitizer tablet. Participants were tested individually on and adjustable chair in front of the digitizer that was placed horizontally on a tabletop. The interval between each trial was 5 to 10 seconds. Two minutes after the completion of the practice trials, the experimenter performed a series of retention trials. Each participant received several warm-up trials before any data collection. Explicit feedback about movement speed was not provided to the subject after each practice or retention trial. (Yan, 2006) | Cross-sectional design with repeated measures 46 females and 42 males, 59-91 years of age 28 carried diagnosis of probable AD 29 had diagnosis of MCI 31 healthy normal controls All participants were right-handed with normal or corrected-to-normal vision 24 or the 29 patients with MCI met the criteria for amnestic MCI (memory decline) Controls were comparable to the AD and MCI patients in terms of age, years of education, and gender distribution. None reported any recent memory problems and scored within normal age-adjusted limits on tests of cognitive, affective, and functional abilities | For all subjects, practice improved motor functions as reflected by faster and smoother motor execution, as well as a greater proportion of programming control AD and MCI subjects showed greater reduction in movement jerk due to practice Significant differences for the baseline tests on jerk, movement time (MT), and percent primary submovement (PPS) (p=0.004) The difference in MT between patients with MCI and AD proved significant (p=0.001) Between groups, there was no significant difference in PPS (p>0.05) |
Intervention: Rotating Treadmill Training: Subjects walked in place on the perimeter of a rotating treadmill (diameter 122cm) rotating at 45 degrees/sec Subjects walked for a total of 10 minutes (Subject 1) and 15 minutes (Subject 2). Each subject was given rests as needed until they had accumulated their allocated time (Hong, 2007) | Design: Pilot Study Inclusion: PD, Freezing during gait | Pre-intervention results for Subject 1 show consistent freezing during Blocks 1-3: 10/10, 10/10, 9/10. Subject 2 showed less freezing but still demonstrated consistent pre-intervention freezing: 5/10, 4/10, 6/10 Post-intervention: no patient froze during leftward turns. |
| Auditory Cueing/Rhythmic Auditory Stimulation (RAS) |
Listenmee and Listenmee smartphone application: synchronizing walking to rhythmic auditory cues to improve gait in Parkinson's disease Patients' baseline control data (during off-period of dopaminergic therapy), was compared to walking task under two conditions: walking with the Listenmee device delivering auditory cues and walking with the Listenmee without any auditory cues. The researchers set the metronome rate (bpm) at a cadence that was 25% faster than the baseline cadence for each patient. The intervention was progressed by first having the patients walk at their fastest speed (for 7 meters) and then having them walk the same distance with the Listenmee powered on. Patients were instructed to synchronize their steps with the auditory cues delivered by the device. (Lopez, 2014) | Quasi-experimental study with participants acting as their own controls Subjects with idiopathic PD (n=10) recruited from a Movement Disorders Clinic and local PD support groups with gait disturbances including freezing of gait (FOG) Outcome measures included: single foot support, walking speed (m/s), average values of opposite foot off, cadence (steps/min), and stride length. | All of the patients showed a significant improvement in gait performance After performing the test with the auditory cues, the mean improvements for the 3 primary dependent variables were the following: cadence (steps/minute) improved by 28.2%, stride length (meters) improved by 44.5%, and walking speed (meters/second) improved by 38.1% Wilcoxin matched pairs signed rank test showed that participants improved significantly on all three variables when they received auditory cues: W= 0; z = 2.52 (p = .0117). |
Patients' baseline cadence in walking calculated during ON period of medication while walking to end of hall During experiment trials, patients walked down to end of hallway, pushed button, turned and walked back, pushing another button at end of hallway (during OFF period of medication) Patients performed 2 trials without auditory stimulation and at preferred (normal) walking (PW) speed Patients performed 2 trials with auditory stimulation at frequency of 110% that of baseline cadence Healthy controls performed 6 trials (Arias, 2010) | Convenience sample taken from Parkinson's Associations PD + FOG (Freezing of Gait) group: 10 (6 males, 4 females, 68.20 yrs. ± 8.03) Patients were told that auditory cues were way to characterize gait FOGQ > 10 for inclusion in PD+FOG group Patients w/ PD but no history of FOG: (6 males, 3 females, 64.44 yrs. ± 9.50) Control group: 10 healthy subjects (8 males, 2 females; 70.20 yrs ±6.84) | No significant differences in UPDRS motor scores between the PD+FOG and PD-FOG groups Significant reduction within the PD+FOG group which went from 59 to 14 freezing episodes when auditory cues applied Mean duration of freezing episodes also significantly reduced in PD+FOG group No significant increase in step length reported |
1 h per day, five days a week for 4 weeks, pts. exercised under two different conditions: in the presence of rhythmic auditory cues (synchronized task) or without auditory cues (reproduction task). No direct training in the test tasks. Exercises: Various forms of gait and Various repetitive UE movements. (del Olmo, 2006) | | Improvement in resting regional cerebral glucose utilization following the improvements in repetitive movement abilities (significant metabolic increment—p<0.001—in the PD group in the right cerebellum and in the right parietal and temporal lobes). |
Effect of auditory and tactile cues on maximal speed gait initiation. Temporal kinematic and center of pressure (COP)were measured with 4 variables (no cue (NC), single auditory cue (SA), repetitive auditory cues (RA) and repetitive cutaneous cues (RC) were recorded with subjects instructed to move at their maximal speed. Measurements included kinematic video analysis, force plate on gait walkway. Ten trials were performed with 4 conditions. (Dibble, 2004) | Design: Controlled clinical design Subjects: 7 PD patients and 7 matched controls Inclusion criteria: Hoehn & Yahr stage 2-3 when on medication, complaints of freezing and akinesia. Exclusion criteria: other conditions that would limit gait or recognize cueing or directions. | PD group responded more slowly in all conditions. With NC, SA, RC and RA there was improvement (decreased double limb support, increased COP displacement and increased velocity) in both groups over self-generated gait initiation. However cueing reduced velocity of limb swing and sacrum, suggesting that sensory cueing may interfere with those body movements. |
Subjects performed 4 weeks (12, 30 min sessions) of supervised individually designed interactive metronome (IM) training limited to the UEs. Clapping to a pre-set beat was used as an assessment of treatment effectiveness. 3D kinematic recordings were used to assess goal-directed movement of the UE. Post-tests were administered immediately after, and at 1 week and 6 months after treatment. Subjective changes were measured via a questionnaire at the same time periods. (Johasson, 2014) | Case-study Children with diplegic CP (n=3) Ages 12-16, 2 M and 1 F, all 3 have multiple co-morbidities and 2 received UE botulinum toxin treatment in the past. | Case 1: modest improvement in self-paced timing ability from pre to post1 and a greater improvement with auditory stimulation with less variability. No significant changes from post1 to post2. No self-reported changes in daily function or muscle tone. Case II: Initial decrease in self-paced timing at post1 that improved slightly at post2. Reduction in movement segmentations (MUs). Reported improvement in less-affected UE and decreased tone in more affected extremity immediately after with some changes remaining after 6 months. Case III: Some improvements in self-paced timing ability without guide signs that was not maintained at post2. Reduction in movement segmentations (MUs). Reported less tone in lesser affected UE and increased ability during self-care and leisure activities at 3 and 6 month follow-up. |
Training of rhythm and timing as a supplement to occupational therapy in stroke rehabilitation Participants received either occupational therapy alone or intervention with an interactive metronome + OT. Intervention occurred 3 times per week for 10 weeks and consisted of 1 hour treatment sessions (Hill, 2011) | Pre test and post test measurements were taken using the Fugl-Meyer Assessment (FM), the Arm Motor Ability Test (AMAT), the Box and Block Test (BBT), the Stroke Impact Scale 2.0 (SIS) and the Canadian Occupational Performance Measure (COPM) | The IM+OT group showed 29.3% increase on the SIS recovery scale, a 65% increase in performance on the COPM, and a 109% increase in satisfaction while participants in the OT only group showed a 6.1% increase on the SIS recovery scale, a 107% improvement in performance on the COPM, and a 23% increase in satisfaction The participants in the OT group improved by 0.5 points on the AMAT, an average of 15.2% (p < 0.05) It may be feasible to add IM to OT. Even though the OT only showed greater gains in function, the OT+IM group showed improved quality of life and decreased impairment |
Patients practiced in their groups for 6 weeks, 3 times per week for 45-60 min with one group receiving Rhythmic Auditory Stimulation (RAS). Evals were performed on the first and last day of practice, as well as 1, 4, and 8 weeks post practice. (Kadiver, 2011) | Matched pairs design Subjects: n= 16 | The RAS group showed a statistically significant improvement at the post treatments tests compared to the IP group for the DGI, TUG, and Tinetti-Gait. This evidence suggests that the implementation of RAS during step training can have long lasting effects |
Intervention: bilateral arm training with rhythmic auditory cueing Auditor cueing was used to synchronize pushing and pulling 2 T-bar handles in he transverse plane for 4 5-minute bouts with 10 minute rest breaks. Sessions: 1 hour 3 x/wk x 6 weeks. Control group: traditional exercise, frequency and duration matched (based on neurodevelopmental principles, weight bearing with affected arm, hand opening scapular and thoracic spine mobilization.) (Luft, 2004) | Design: Randomized controlled clinical trial. Subjects: n= 21 Inclusion criteria: chronic CVA with spastic hemiparesis, with at least ability to move partial range against gravity and had convention al therapy for 3-6 months. MRI was performed 2 weeks before and after intervention and brain activation during elbow movement was assessed. Fugl-Meyer scores were also obtained pre/post intervention. | The experimental group had increased hemispheric activation with affected arm movement (p=.03) compared to controls. Increased activity was found in contralesional cerebrum and ipsilesional cerebellum (p=.009), in precentral (p=<.001) and post central gyri (p=.03) and cerebellum (p=<.0001). There were significant changes Fugl-Meyer scores in experimental group (p= .02). Evidence suggests bilateral training may induce cortical and cerebellar reorganization in this population. |
Two conditions (single-present and single-absent) are used to determine whether one single auditory cue can affect movement kinematics in a sequential UE task in patients with PD. The movement observed is reaching for a pen, bringing it to paper, and writing "Call 1-800-6060". During single-present condition, subjects are told to start the movement when they hear the bell ring. During the single-absent condition, the subjects are told to start the movement when ready. Three practice trials preceded the five test trials for each condition. (Ma, 2004) | A counterbalanced, repeated measures design Sample of convenience 2 groups: PD-16 men; Control: 12 healthy men and 4 healthy women. Control group age matched to PD group. Inclusion criteria: Hoehn and Yahr stage II or III, 40-75 yrs of age, stable med usage, normal to corrected-normal vision and hearing, and no history of other neuro disease or musculoskeletal disorders affecting UE movement Dependent variables were movement time, amp of peak velocity, ratio of peak-to-avg velocity, number of movement units, and movement variability A P value <0.05 was considered statistically significant One tailed p values found; two-way analysis and post hoc analysis were used for data collection n=32 | PD subjects produced faster and more forceful movement in the single-present condition vs single-absent condition In the measured 2 steps of the 3 step movement task, shorter movement time and peak velocity were found during the single-present condition Significant and large effects of start signals were found in the PD group but not in control group External auditory cues give patients with PD faster, more forceful, more efficient, more stable, but less smooth movements for at least two steps Movement of the patients was characterized by shorter movement time, higher peak velocity, lower PV/AV in the first step only, and lower movement variability in the single-present condition than in the single-absent condition. For the first step in the three-step task, significant condition effects on all dependent variables (movement time p=0.0099, peak velocity p=0.0376, PV/AV p=0.0198, movement variability p=0.0288) except for the movement units (p=0.2667). For the second step, significant condition effects on movement time (p=0.0385), peak velocity (p=0.0008), and movement units (p=0.0303), but not significant on PV/AV (p=0.7598) or movement variability (p=0.2436) The results also indicated that the effect of start signals was significantly larger in the Parkinson's Disease group than in the control group in the variable of peak velocity (p=0.01). For this group, the peak velocity was higher in the signal-present condition than in the single-absent condition. The control group had similar amplitude of peak velocity under both conditions. |
Weekly session of MT and PT were administered for three months. (Pacchetti et al, 2000) | | MT had a significant effect on bradykinesia measured by the Unified Parkinson's Disease Rating Scale (p<.034) Motor improvement was shown after MT especially in bradykinesia items (p<.0001) Improvements in ADL's and quality of life were also noted |
Musical Instrument training (Active), using MIDI-piano or electronic drum pads, combined with conventional therapy prescribed by the neurologist (PT or OT) for 30 min, 2 groups: 1 treatment group receiving musical training, 1 control group, training applied 15 30 minute sessions over a 3 week period (Schneider, 2001) | Music supported training program design Included CVA patients with moderate impairment of upper extremities (n=40); divided to two groups: treatment group and control group Mean age- treatment group 58.1 Mean age- control group 54.5 Mean time post stroke-treatment group 2.1mos, Mean time post stroke- control group 1.9mos. | Treatment group had substantial improvement in the Action Research Arm Test (p<.001), Arm Paresis Scores (p-.014), BBT (p<.001), and the Nine Hole Pegboard Test (p=.035) Treatment group also improved in finger and hand tapping frequency and smoothness |
Rhythmic Auditory Stimulation (RAS) and neurodevelopmental therapy (NDT) are both interventions to help improve gait function. This study involving two groups of hemiparetic stroke patients lasted over a three-week period with 30 min sessions, 5 times per week. RAS training was conducted using a metronome. During the first quarter of the session, cueing frequencies were matched to gait cadence. The second quarter frequencies were increased by 5% increments. During third quarter, adaptive gait patterns, ramp or step walking, were practiced. The last quarter was spent fading the cues randomly for carryover. NDT was practiced in the same manner but s auditory cuing. Pre- and posttest measures were taken for each condition. (Thaut, 2007) | Experimental design; single-blind, randomized trial 2 groups: 43 subjects in RAS experimental group (mean age=69.2, 22:21 male:female ratio, mean days since stroke=21.3) and 35 subjects in NDT training group (mean age=69.7, 19:16 male:female ratio, mean days since stroke=22.2) Fugl-Meyer scores were 31.4 and 33.3 and Barthel Index scores were 45.5 and 47.5, NDT and RAS group respectively. Lavene's F test and 2-tailed t tests compared variables n=78 | At pretest, no significant differences were found between the 2 groups in each parameter: velocity (p=0.347), stride length (p=1.111), cadence (p=0.141), and swing symmetry (p=0.258) At posttest, significant differences were found in favor of RAS training in all 4 parameters: velocity (p=0.006), stride length (p=0.0001), cadence (p=0.0001), and swing symmetry (p=0.006) Both group showed improvements over the 3 weeks Temporal-rhythmic motor cues do not only cue speed and timing of movement but also help to restore motor function in brain rehab. |
Rhythmic auditory stimulation (RAS) was used as a pacemaker during a 3-week home-based gait-training program. RAS consisted of audiotapes with metronome-pulse patterns embedded into the on/off beat structure of rhythmically accentuated instrumental music (Thaut, 1996) | | Electromyogram (EMG) patterns and stride parameters RAS significantly (p < 0.05) improved gait velocity by 25%, stride length by 12%, and step cadence by 10% more than self-paced subjects and no-training subjects. In the RAS-group, timing of EMG patterns changed significantly (p < 0.05) in the anterior tibialis and vastus lateralis muscles. Evidence for rhythmic entrainment of gait patterns was shown by the ability of the RAS group to reproduce the speed of the last training tape within a 2% margin of error without RAS. |
Investigation of the hypothesis that bilateral arm training with rhythmic auditory cueing (BATRAC) will improve motor function in the hemiparetic arm of stroke patients. The effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke (median time after stroke, 30 months) immediately after training and at 2 months after training was determined. Four 5-minute periods per session (3 times per week) of BATRAC were performed with the use of a custom-designed arm training machine. (Whitall, 2000) | Inclusion criteria: ability to follow simple instructions and 2 step commands, volitional control of the nonparetic arm, at least minimal antigravity movement in the shoulder of the paretic arm. | The patients showed significant and potentially durable increases in the following: Fugl-Meyer Upper Extremity Motor Performance Test of impairment (p<0.0004), Wolf Motor Function Test (performance time measure, p<0.02), and University of Maryland Arm Questionnaire for Stroke measuring daily use of the hemiparetic arm (p<0.002). Isometric strength improved in elbow flexion (p<0.05) and wrist flexion (p<0.02) for the paretic arm and in elbow flexion (p<0.02) and wrist extension (p<0.02) for the nonparetic arm. Active range of motion improved for paretic-side shoulder extension (p<0.01), wrist flexion (p<0.004), and thumb opposition (p<0.002), and passive range of motion improved for paretic wrist flexion (p<0.03). |
The intervention consisted of a 2-week program. Participants completed 1hour/day of onsite training followed by 2 hours of home-based training on Monday, Wednesday, and Friday. Tuesday and Thursday were home training days where participants completed 3 hours of home-based training and answered a research assistant's questions. The rhythmic auditory stimulation (RAS) training procedure incorporated movement timing, range of motion, and feed-forward processing. Outcome measures included motor control assessments using kinematic motion analysis of a reaching task, the Wolf Motor Function Test (WMFT), and the Fugl-Meyer Upper Extremity Assessment. (Malcolm, 2009) | Pre-test post-test Pilot study Male survivors of stroke (n=5), sustained at least 6 months prior to study Mean age 72.8 ±6.5 Hemiplegic presentation At least minimal motor function in paretic arm 10° active finger extension and 20° active wrist extension Passive ROM of all upper extremity motions of at least half normal range | Trunk movement significantly decreased from 8.6±4.6 cm pre-RAS to 6.22±2.34 cm post-RAS (p=0.002). Shoulder flexion accounted for 12.54±6.47 cm before RAS and significantly increased to 15.25±5.22 cm post-RAS (p=0.001). Movement time to complete four reaching cycles significantly decreased from 8.08±3.1s pre-RAS to 6.22±1.9s following RAS (p=0.0245). Mean reaching velocity increased significantly from 35.2±28.1 cm/s pre-RAS to 42.2±24.9 cm/s post RAS (p=0.021). WMFT performance time significantly decreased from 48.3 s pre-RAS to 35.0s (p=0.0075). |
| Visual Cueing |
Focus was on strategies to decrease freezing gait. Training with visual cues, conditions including obstacles, narrow passages, turning, auditory cues to improve cadence and velocity, cognitive strategies, walking in conditions including eyes open, eyes closed, heel and toe walking, ADL simulation (ie. walking to answer phone), balance and postural control exercises in quadruped, kneeling, unilateral standing. Sessions: 3 x/wk x 6 wks, 45 min sessions. Programs were individualized. (Brichetto, 2006) | Design: Prospective, uncontrolled pilot study Patients with clinically probable idiopathic PD (n=12) Inclusion criteria: Hoehn-Yahr stage 2-3, with complaint of freezing gait during peak medication effect. Measurements were taken at baseline, conclusion of therapy and one month follow up: Motor section of Unified Parkinson Disease Rating Scale, Freezing of Gait Questionnaire (FOGQ) and Parkinson disease Quality of life Questionnaire (PDQOL). | Significant improvement on FOGQ and PDQOL at conclusion of study but not at baseline 5 of 12 subjects had a total of 11 freezing episodes. One month follow up - Friedman's Test (non-parametric one-way analysis of variance for repeated measures. At study conclusion there were no freezing episodes. At follow up 3 subjects had a total of 7 freezing episodes. Conclusion: tailored programs can reduce freezing episodes and improve gait parameters, but benefits are transient. |
The study investigated the effects of external cues on motor control of the ankle joint during gait initiation in PD patients and healthy subjects. Patients were asked to step forward once they were given a visual cue. A control group was present in which no visual cue was given Soleus H-reflex and background EMG activity in ankle joint muscles were then recorded. (Hiraoka, 2005) | Design: Experimental design Patients with idiopathic PD (n=9) who could make at least two steps forward without assistance or instrumental aids, and seven age-matched healthy subjects. The subjects with PD had Hoehn and Yahr stages that ranged from 2-4 | External cues significantly increased soleus H-reflex depression during gait initiation in PD patients (p<0.05), The tibialis anterior generated force during cue-triggered gait initiation was significantly larger than that during self-generated gait initiation in both groups (PD patients: tZ2.31, p<0.05; healthy subjects: t=3.41, p<0.05). The soleus-generated force during cue-triggered gait initiation was not significantly different between the two types of gait initiation in both groups (PD patients: T=1.15, p<0.28; healthy subjects: t=0.50, p<0.63). |
Auditory cues (rhythmic sounds) and visual cues (high-contrast transverse lines on the floor) are used to measure kinematic recordings of length of steps, overall velocity, and timing. Baseline trials preceded the 10 trials for each cue condition. The auditory cue is created by a Piezo buzzer which produces a high pitched beep of approx. 40 ms duration, set to each subject's avg step time from baseline trials. The visual cue is a series of 4 strips 1.9 cm in width taped to the floor. The first strip is placed at the subjects avg first step length from baseline trials. The following strips are placed at 40% of the subject's height. (Jiang, 2006) | A single repeated measures analysis of gait initiation performance 2 groups: 7 subjects who reported experienced freezing (F) when walking and 7 subjects who did not experience freezing (NF) Inclusion criteria: dx of PD, able to walk indoor distances s any physical assistance or AD Exclusion criteria: vision or hearing inadequate to perceive the cues, dx c any other neurologic disease or musculoskeletal problems that might influence gait Groups compared using t-test analysis and chi-square analysis; p=0.05 ANOVA used to measure the dependent variables; p=0.01 Post-hoc analysis c Bonferroni correction used to compare pairs of conditions between groups | Transverse line visual cues improved gait initiation in people c PD Improvements were seen in the length of steps, magnitude of push-off force, and overall velocity Rhythmic auditory cues had no systematic effect on gait initiation Neither type of cue is associated in the timing of gait initiation Neither cue had a significant effect on the timing of any of the events in the gait initiation process Significant effect of cueing on first step length; visual cue condition improved first step length by 19% when compared to baseline Visual Cue showed significance with magnitude of first step length, second step length, push-off force, and overall gait velocity; however, no p-values given in article |
Movement initiation may be facilitated by visual external cues. An adapted noise-compatibility paradigm (replaced customary letters by left/right arrows) was used to measure initiation. Initiation of hand movements is defined as stimulus-onset until switch closure (when response key was fully depressed). Lateralized movement-related cortical potentials were recorded. Two flanker types assessed: compatible and incompatible. Four stimuli conditions were assessed: left compatible-all 9/9 arrows facing left, right compatible-all 9/9 arrows facing right; left incompatible-all but 1/9 arrows facing right, and right incompatible-all but 1/9 arrows facing left. (Praamstra, 1998) | Experimental design 2 groups: 7 subjects in PD group (6:1 male:female ratio, mean age=59) and 7 subjects in control group (6:1 male:female ratio, mean age=60). All participants were right handed and classified as 2, 2.5, or 3 on the Hoehn and Yahr scale EEG, EOG, EMG recorded MANOVA procedure analyzed reaction times for correct trials T test used for difference between groups with incorrect lateralization of the LRP | No significant differences in the compatible condition; the PD group (502 ± 74 ms) reacted as fast as control group (503 ± 92 ms) Significant differences (p<0.05) in the incompatible condition; the PD group (586 ± 81 ms) reacted slower than the control group (557 ± 91 ms) Number of arrows was low with almost all errors (89%) occurring in the incompatible condition A positive correlation was found between the magnitude of incorrect LRP activation and the reaction-time delay in the incompatible condition (r= 0.75, p<0.01) The difference between groups was larger in the compatible than in the incompatible condition with LRP latency and showed significance (p<0.05) Visual evoked responses were not significant between groups and variables were not significant within groups PD group had stronger erroneous response tendencies and delayed correct response more than the control group PD group required more time to stop false movements than control group |
Study was done to see the effectiveness of therapy if it includes mirror therapy on patients with severe hemiparesis of the upper extremity. Mirror therapy on arm, hand and finger movements was performed for 30 minutes a day, 5 days a week for a total of six weeks. Outcome measures that were used the Fugl Meyer upper extremity test, Action Research Arm Test and FIM (Dohle, 2009) | Randomized Control Trial N= 36 Ages range from 25-80 years First ischemic stroke confined to the middle cerebral artery which had occurred no later than 8 weeks prior to the study Exclusion criteria: experienced previous strokes, major hemorrhagic changes, increased intracranial pressure, hemicraniectomy or orthopedic, rheumatologic, or other diseases interfering with their ability to sit or to move either upper limb. | |
| Motor Imagery |
Motor Imagery was used as an intervention to treat movement initiation and timing disorders Subjects were asked to perform a squeezing reaction time task with and without an imagined movement. Reaction time and motor evoked potentials were measured. (Li, 2009) | Design : Experimental Design Health Adults (n=9); 1 male, 8 female; Mean age = 24.6 All right hand dominant Inclusion criteria: healthy adults Exclusion criteria: history of a neurological disorder or musculoskeletal injury of the UEs, history of brain injury or seizure, any intracranial metal objects, a pacemaker, or other implanted devices | Motor Evoked Potentials (MEPs) were significantly increased for the finger flexors during imagined finger flexion and for the finger extensors during imagined finger extension at all transcranial magnetic stimulation (TMS) delivery time points RT was slower when they were imagining finger extension prior to the visual cue Motor imagery can be integrated into a rehabilitation protocol to facilitate motor recovery. |
Motor Imagery & Physical Practice: Experimental group received a combination of imagery and physical practice. The control group received only physical practice on the same motor tasks. For each group, 1-h practice sessions were held twice a week for a total period of 12 weeks. Outcome measures with performance time (sec) as criterion measurement included: performance of movement sequence (TUG, standing up & lying down, turning in place 360°), balance tasks (tandem stance), and cognitive tasks (Stroop Test- parts A & B). (Tamir, 2007) | RCT Community-dwelling subjects with idiopathic PD. Inclusion criteria: Hoehn & Yahr's classification of PD between stages 1.5-3, no dementia (MMSE score of at least 26 points). n = 23 (12 from combined therapy group, 11 from PT only group; 2 dropouts, one from each group). | There was significant improvement in the performance time for: 1)TUG (t=3.80, df=40, p= 0.0005), 2) getting up from a supine position (t=3.53, df=19, p=0.0023), and 3) number of steps required to rotate in a circle (t=3.31, df=61, p=0.0016). No parallel changes were found in the control group. The tandem stance test score was not affected by the intervention in either group. Scores on Stroop test part A showed a nonsignificant improvement in the experimental subjects, while there was a marginally significant improvement for part B (p = 0.1). The authors report a combination of motor imagery & real practice may be effective in reducing bradykinesia in patients with PD. The authors also report the combination of motor imagery & physical exercises for at least 6 weeks (or 12 visits) has shown to positively affect motor/functional tasks of patients with PD. |
| Virtual Environment Interventions |
30 minute sessions of gravity compensation training using a virtual reality augmented environment 3 times a week for 6 weeks If the patient's score improved during the FurballHunt game (indicating improved arm function) the level of gravity compensation was decreased by the therapist approximately 10%. Starting position was standardized to have the subject's upper arm along their trunk, elbow bent approximately 90 degrees and hand on the start button. (Krabben, 2012) | Pilot study n=7 Individuals with chronic (>6 months) unilateral left hemisphere stroke (n=7), able to move elbow and shoulder against gravity but not able to hold against gravity and moderate resistance Adequate cognitive function to give feedback and to follow directions | Statistically significant and clinically relevant improvement in group median proximal upper extremity Fugl-Meyer Assessment score (p=0.017) (3.5 points) Unsupported circle drawing: Results showed a statistically significant increase in median normalized circle area (p=0.018), but no significant change in circle roundness (p=1.0) 35% of the movement at baseline was within a synergistic pattern, which decreased to 27.9% following intervention. The percentage of movement out of a synergistic pattern and in a single joint movement pattern increased. None of these changes were statistically significant. |
This study compared the effectiveness of avatar feedback to Air Hockey 3D video game feedback with varied arm support. While playing Air Hockey 3D subjects were instructed to reach as far as possible. Two trials of 3 minutes were repeated for each condition of loading with 1-minute rest periods between trials. Subset of 5 subjects repeated the Air Hockey 3D game with an adjusted mapping technique that forced the subject to extend their elbow maximally. While receiving avatar visual feedback subjects were instructed to reach within the workspace to 1 of 3 targets. Under each loading condition subjects reached to each target 7 times with 30 second rest breaks between trials. The order of target and loading selections was randomized. (Acosta, 2011) | Pilot study Individuals with chronic unilateral hemiparetic stroke (n=7), age: 50-80 years Initial Fugl-Meyer Motor Assessment (upper limb portion) score: 10-43 (flexion synergy moderate to severe) | Reaching distances with avatar feedback were significantly greater (p<0.05) than when playing air-hockey 3D across loading conditions, subjects and reaching directions. Reaching distances were still greater with avatar feedback compared to the map adjusted Air Hockey 3D. Air Hockey 3D was chosen over avatar feedback by all subjects perhaps due to the challenging yet fun experience. Although subjects were verbally encouraged to reach as far as possible during Air Hockey, there was avoidance of reaching out of the flexion synergy; this needs to be addressed in the development of new games. |
This study compared the clinical and kinematic outcomes of dose-matched upper extremity training between a virtual environment and a physical environment in chronic stroke patients. Virtual 3D environment was made by CAREN (Computer Associated Rehabilitation Environment) software, and it included a supermarket environment that prompted the patient to reach for products on a shelf. They pointed to six targets, 12 times each (for a total of 72 trials per session), for 12 sessions over 4 weeks. Physical environment included a wooden frame with six numbered, square targets. Patients had to reach for indicated targets, and movement analysis was conducted by CAREN software system. Improvements in individual joint control were assessed by the elbow extension clinical impairment scores, and the shoulder horizontal abduction scores, which could show improvements (decrease) in abnormal synergies and increase in motor control. (Subramanian, 2012) | Design: double-blind RCT Patients (40-80 years old) who had suffered a single stroke (n=32) 6-60 months prior to the study were included. Feedback such as precision, movement speed, and trunk displacement were calculated by CAREN software. Primary outcome measures (kinematics, clinical arm motor impairment) and secondary outcome measures (activity level, arm use) were obtained prior, post, and at follow-up of study. | Both the virtual environment group and physical environment group significantly improved in arm motor impairment scores of end point velocity and shoulder horizontal abduction at both post-intervention (p<.05; p<.01, respectively) and follow-up (p<.05; p<.05, respectively). Both groups improved in elbow extension clinical impairment scores (p<.05), which were assessed by the Reaching Performance Stroke Scale (RPSS). Both groups improved in activity scores (p<.05) of Wolf Motor Function Test (WMFT). Authors conclude that improvements in both groups are more attributable to practice intensity than the "medium" of therapy (virtual environment vs. physical environment). |
Subjects participated in 16 video gaming sessions to impact effects of stroke. Participants were asked to participate twice a week, in 15-minute sessions, for 8 weeks. The three specific games targeted the participant's https://www.youtube.com/watch?v=YlYW_3kv2t8fine motor abilities in a sitting position. Participants played these video games on a Wii and the uDraw Game Tablet. The three games played were Kororinpa-Marble Mania, uDraw Spongebob Squigglepants, and uDraw Alien Splat. The games increase in difficulty as the participant masters each level. These three games were played in addition to their current exercise program, which consisted of gross motor training and balance exercises. (Paquin, 2014) | Quasi-experimental design Subjects with chronic stroke, https://www.youtube.com/watch?v=YlYW_3kv2t812 or more months past stroke (n=10), with a score of at least a 22 on the Mini Mental State Examination, and at least a 10 on the upper extremity portion of the Fugl-Meyer Assessment. | Significant improvements were observed in the post-test measures for: Jebsen Hand Function Test (JHFT), Box and Block Test (BBT), Nine Hole Peg Test (NHPT), and in participants perceived quality of life (QOL). Motor control can improve with this intervention, even in chronic stroke patients. The results of this study suggest that video gaming improves the ability to demonstrate increased fine motor control in participants who are in the chronic phase of a stroke. More affected hand: JHFT: p=0.031 BBT: p=0.030 NHPT: p=0.016 Less affected hand: JHFT: p=0.012 BBT: p=0.009 NHPT: p=0.048 QOL: p=0.009 |
| Miscellaneous Interventions |
Intervention: Mime therapy. The purpose to reduce synkinesis and facial asymmetry during movement and rest. Sessions were 10- 45 minute periods over 3 months. Therapy had 6 components: Self massage to bilateral face and neck, stretching to affected side. Education in recognizing tension and relaxation in musculature. (Synkinesis can increase muscle tone and is affected by stress) Exercise to decrease synkinesis and coordinate both halves of face using a mirror for feedback: bilateral face movements (puckering, forehead wrinkling) at different amplitudes and speeds and unilateral exercises to control separate movements: slow small movements and counteraction to inhibit synkinesis. Eye and lip closure exercises. Various eye movements while keeping lips closed and vice versa. Exercises to increase consciousness of lip movement/mouth position while making sounds Mime exercises for expressions to increase awareness of muscle action and facial emotion expression. (Beurskens, 2006) | Design: Prospective randomized design. Subjects: N=50. Control group was on waiting list for treatment. Inclusion criteria: unilateral peripheral facial nerve paresis of >9 months, age 18 or <. Excluded if congenital origin or previous surgical reconstruction. Pre and post test of experimental and control groups using video analysis. Outcome measures: Sunnybrook Facial Grading System (SFG) (examines facial symmetry at rest, with voluntary movements and synkinesis. House-Brackmann Facial Grading System (HBFG) measures severity of paresis(Scale I-VI, I=normal, VI=total paralysis) | There was 100% improvement in facial symmetry in the experimental group versus 38% in controls. None of the control group had reduced paresis while 88% of experimental group had reductions. Experimental group had 20.4 point (95% CI 10.4 to 30.4) increase in facial symmetry scores on SFG. Paresis was reduced in experimental group by 0.6 grade on HBFG. Resting eye asymmetry was the only aspect of SFG that showed no change. |
Task Training Education: Phase B: a 4.5mo period of special education (2hr/wk of individual PT/OT) Phase A: 9mo period of conductive education was administered in 3 blocks of 4 wks (7hr/day from Mon-Fri) B/t the blocks, special education was applied as in the B phase (Blank et al, 2008) | | Conductive education improved coordinative hand functions by 20-25% from baseline, compared w/ no improvement during special education: Preferred hand improved from 0.38 to 0.48 (mean change=0.10; 95% CI, 0.086-0.114) Non-preferred hand improved from 0.39 to 0.47 (mean change-0.08; 95% CI, 0.034-0.116) ADL improved by 0.11 (95% CI, 0.070-0.149), from 0.50-0.61 (20%) compared with no improvement under special education. |
Action Observation Therapy: consisting of watching daily arm activities on a TV and then repetitive practice of these tasks lasting 90 min for 18 days, 2 groups: 1 treatment group receiving the above therapy, 1 control group, which performed the same tasks, but watched geometric symbols and letters on the TV instead of arm movements (Ertelt, 2007) | Randomized, controlled trial 2 groups (n=15): control group and treatment group (ages 38-69) Post-ischemic stroke (≥ 6 mo prior to study) | Treatment group's motor function improved significantly base on the Frenchay Arm Test (FAT) (p<.0005) Treatment group showed significant improvement on the Stroke Impact Scale (SIS) (p<.0025) After 8 wks, there was no significant decline of clinical status based on the FAT, SIS, and WMFT (p<.7) MRI scanning of both groups pre/post treatment concluded that the same areas of the brain were activated during observing and performing actions |
Examined postural control, degree of forward bending, gait initiation and coordination of movement while walking. Control group received nonspecific psychological and physical treatment. Pre/post measurements performed with electronic movement analysis with ELITE system. Experimental Behavioral group focused on strategies to improve motor behavior such as cueing while walking or during a freezing episode. "Chaining" was a technique used to divide complex movements into smaller components. Gait training included video feedback and behavior rehearsal. For use in stressful situations progressive muscle relaxation was taught. Sessions: Both groups received 2 11/2 hour sessions for 10 weeks. (Muller, 1997) | Design: Controlled clinical study Subjects: all with PD, 15 PD patients in experimental group and 14 controls. Inclusion criteria: All PD patients were tested on medications. Those with depression dementia or other psychiatric disorders were excluded. | Two-way ANOVA performed with the following Beck Depression Inventory: Improvement in both groups [F(1,27) = 5.23, p=0.03] Unified Parkinson's Disease Rating Scale, subsection: Motor Exam: Significant improvement only in behavioral group [F(1,14) = 6.97, p=0.01] Hoehn & Yahr Scale: Significant improvement only in behavioral group [F(1,14) = 4.1, p=0.05] Initial posture: no change Forward bending: worsening in control group Gait initiation: faster onset of movement [one tailed t(27) = 2.11, p=0.02] Movement coordination: no significant change |
Deep Brain Stimulation (DBS), in which electrodes were implanted bilaterally into the subthalamic nucleus, 1 treatment group compared DBS on and off (Nilsson, 2005) | | Treatment group showed significant improvements in the Berg Balance Scale at 6 (p=.001)and 12 (p=.0004) months after surgery compared with DBS off Postural stability (p<.01) and motor symptoms improved significantly with DBS on, using the Unified Parkinson's Disease Rating Scale (UPDRS) |
Problem-oriented willed-movement therapy (POWM) is designed to guide tasks based on patients' cognitive and movement problems by focusing on the movement task and focusing on the movement function, cognitive problems and perceptual function. This was compared to NDT. Sessions: Both groups received 5 to 6 50-minute sessions per week. (Tang, 2005) | Design: Randomized block design Subjects: N=47 Outcome measures: Stroke Rehabilitation Assessment of Movement (STREAM) looks at UE and LE movements and mobility, Mini-Mental State Exam | Significant improvement in LE mobility, basic mobility and total mobility with POWM versus NDT. No benefit was found with respect to UE mobility. Subjects with higher cognitive ability had more improvement overall with NDT versus POWM. POWM had greater effect on those with lower cognitive ability presumably due to tasks being more tailored to their deficits. |
FTM Dynamic Splinting: Functional arm training with a Functional Tone Management (FTM), a dynamic splint which allows stroke patients to quickly incorporate grasp and release function in upper extremity movement. Treatment intervention consisted of 5 days of therapeutic treatment and training, 6 hours per day with repetitive, task oriented arm movements using the FTM dynamic splint, movement specific exercises using the Hemi-Glide exercise device, and neuromuscular electrical stimulation targeted to the wrist and finger extensors. (Farrell, 2003) | | Data analysis using paired t-tests showed significant improvements in shoulder flexion, shoulder abduction, elbow flexion, elbow extension, and wrist extension. Additionally, all 3 qualitative assessment tools-the Fugl Meyer, the Motor Status Assessment, and the Modified Ashworth-showed statistically significant improvements. |
Medication Therapy: Group A received conventional PT and medication therapy (MT) for the first 6 weeks, followed by MT only for the second 6 weeks. Group B received only MT for the first 6 weeks and PT and MT for the second 6 weeks. (Ellis, 2005) | Experimental crossover design Subjects with typical, idiopathic PD (n=68); Hoehn and Yahr stage II or III, Stable medication use | Analysis revealed a significant improvement of the group with both PT and meds. (p=.015) after the initial 6-week intervention period (t0 to t6) This indicates a significantly improved QOL score as it relates to physical mobility compared with the control period However these gains did not persist for the 6 wks which was followed w/ no PT The improvement of the Unified Parkinson's Disease Rating Scale (UPDRS) and comfortable walking speed (CWS) did persist. |
Mirror Therapy & LE motor recovery: Both groups participated in conventional stroke rehabilitation (PT, OT, speech, neurodevelopmental facilitation techniques) for 2-5 hrs/day, 5days/wk, for 4 wks. The treatment group received an additional 30 min/day of mirror therapy program (non-paretic ankle DF movements). (Sutbeyaz, 2007) | Randomized, controlled, assessor-blinded trial Subjects within 12mos post-stroke (n=40) with no volitional DF; with half in treatment group (mean age 62.7±9.7 yrs), and half in Control group: (mean age 64.7±7.7 yrs) All had Brunnstrom stages of LE between 1 and 3. | FIM motor score: 21.4; 95% CI, 18.2-24.7 vs. 12.5; 95% CI, 9.6-14.8; p=0.001 |
Both the mirror group and the control group participated in a conventional stroke rehabilitation program for 5 days a week, 2 to 5 hours a day, for 4 weeks, The program consisted of wrist and finger flexion and extension movement or sham therapy in addition to conventional stroke rehabilitation. The objective of the study was to look at the effects of mirror therapy on the upper extremity motor recovery, spasticity and hand related functioning of patients with acute stroke. The out come measures used were the Brunnstrom stages of motor recovery, Modified Ashworth Spasticity scale and FIMs. (Yavuzer, 2008) | Randomized Controlled trial Assessors were blinded 4 week trial with a 6 month follow up N= 40 inpatients with a CVA Brunnstrom Stages between I and IV for the upper extremity | There was more improvement in the mirror group than in the control group. Baseline measurements from baseline to post-treatment: Brunnstrom stage of the hand the mean difference of the mirror group was .83 (p = .001), Brunnstrom stages of the upper extremity mean difference was .89 (P value of .001) and FIM mean difference was 4.10 (p = .001). there was no mean difference in MAS with a p = .925 Post-treatment to follow-up: Brunnstrom stage of hand and upper extremity mean differences .16 (.048) and .43 (.006) respectively. FIMs mean difference 2.34 (.001). No significant difference in MAS measures with p= .876 |
Computer-based cognitive rehab training program: Subjects participated in a 10-day training of a 2-phase button press task. There was a control group and the Parkinson Disease (PD) participants were divided into 2 groups (impaired (I) vs unimpaired (U) –based on pre-training task performance). Each group was evaluated for average reaction times on the training task (EC sequence initiation, EC sequence completion, Internal representation (IR) sequence initiation, IR sequence completion). Cognitive flexibility (Trails A & B) and performance of an internally represented motor sequence (TUG) were measured. (Disbrow, 2012) | | EC sequence initiation = there was a significant decrease in reaction time after training (F=170.61, p=0.001). There was a significant main effect of group (F=9.93, p=0.001). I-PD group had slower EC sequence initiation times than the U-PD group and control group. There was no significant difference between the control & U-PD groups. There were no differences across groups in improvement over training. EC sequence completion time = there was a significant decrease in reaction time after training (F=447.30, p=0.001. There was a significant main effect of group (F=13.20, p =0.001). I-PD group had slower sequence completion times than the U-PD group and control group. There was no significant difference in between U-PD and controls. IR sequence initiation = there was a significant decrease in reaction time after training (F=200.8, p=0.001). There was a significant main effect of group (F=5.9, p=0.005). I-PD group had slower IR sequence initiation times than the U-PD group but not the control group. There was no significant difference in time for the U-PD and control groups. IR sequence completion time = there was a significant decrease in reaction time after training (F=195.4, p<0.001). There was a significant main effect of group (F=7.69, p=0.001). I-PD group had slower IR sequence completion times than the U-PD group and the control group. There was no significant difference between the U-PD group & controls. TUG = there was a significant Training X Group interaction (F=3.24, p=0.048), and no significant differences across groups over training. There were no significant main effects for Group or Training. After completing a computer-based adaptive training program, movement initiation was improved in patients with PD. Following training, the I-PD group showed a more significant decrease in reaction time for both sequence initiation and completion time compared to the U-PD and control groups. |
Incentive Based Therapy Participants completed 2 sessions with a one-week break between sessions. The experimental group was evaluated to determine if monetary incentive would increase movement initiation and movement execution on a computer based timed task. The experimental group was also compared to a control group using age-matched healthy participants. Outcomes measured were: movement initiation, movement execution, anticipation errors, and long responses. (Kojovic, 2013) | Randomized Controlled Trial Patients diagnosed with idiopathic PD (n=22) Experimental group: Control Group: Patients tested both "on" and "off" medication cycles. All subjects tested in two different sessions separated by 1 week. | Significant main effect was found for faster initiation time (IT) (F = 32.3, p<0.001) due to shorter IT in Blocks 3-4 in relation to Block 1. Suggesting that as incentive increased so did initiation of movement. Post hoc analysis revealed that there was no statistical difference, between "on" or "off" medication, on subject performance. This suggests that PD patients both "on" and "off" their medication initiated movement faster the more incentive they were given. PD patients "off" medication had significantly more anticipation errors than subjects "on" medication (x2 (2, N = 33) = 22.5; p < 0.001). This suggests that PD patient's medication can increase the reliability of a patient's movement as well as make fewer errors. |