Evaluation of a functional hand orthosis combined with electrical stimulation adjunct to arm-hand rehabilitation in subacute stroke patients with a severely to moderately affected hand function.

Autor:	Franck JA; a Department of Brain Injury Rehabilitation , Adelante Rehabilitation Centre , Hoensbroek , the Netherlands.; b Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , the Netherlands., Smeets RJEM; c Department of Rehabilitation Medicine , Maastricht University, Research School CAPHRI , Maastricht , the Netherlands., Seelen HAM; b Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , the Netherlands.; c Department of Rehabilitation Medicine , Maastricht University, Research School CAPHRI , Maastricht , the Netherlands.
Jazyk:	angličtina
Zdroj:	Disability and rehabilitation [Disabil Rehabil] 2019 May; Vol. 41 (10), pp. 1160-1168. Date of Electronic Publication: 2018 Jan 09.
DOI:	10.1080/09638288.2017.1423400
Abstrakt:	Purpose: To investigate the usability and effectiveness of a functional hand orthosis, combined with electrical stimulation adjunct to therapy-as-usual, on functional use of the moderately/severely impaired hand in sub-acute stroke patients. Materials and Methods: Single case experiment (A-B-A'-design) involving eight sub-acute stroke patients. The functional hand orthosis and electrical stimulation were used for six weeks, four days/week, 45'/day. Outcome Measures: Action_Research_Arm_Test, Intrinsic_Motivation_Inventory. Results: At group level, patients improved 19.2 points (median value) (interquartile range: [8.8, 29.5] points) on the Action_Research_Arm_Test (p = 0.001). After correcting for spontaneous recovery and/or therapy-as-usual effects Action_Research_Arm_Test scores still improved significantly (median: 17.2 points; interquartile range: [5.1, 29.2] points) (p = 0.002). At individual level, six patients had improved as to arm-hand skill performance at follow-up (p < = 0.010). In one patient, arm-hand skill performance improvement did not attain statistical significance. In another patient, no arm-hand skill performance improvement was observed. Average Intrinsic_Motivation_Inventory sub-scores were between 4.6 and 6.3 (maximum: 7), except for 'perceived pressure/tension' (3.3). Conclusion: Sub-acute stroke patients who display only little/modest improvement on their capacity to perform daily activities, seem to benefit from training with a dynamic arm orthosis in combination with electrical stimulation. Patients' perceived intrinsic motivation and sense of self-regulation was high. Implications for rehabilitation Arm-hand training featuring the dynamic hand orthosis in combination with electrical stimulation shows a shift from no dexterity to dexterity. As to the users' experience regarding the dynamic hand orthosis, patients perceive a high-intrinsic motivation and sense of self-regulation. Combining the orthosis with electrical stimulation creates opportunities for a nonfunctional hand towards task-oriented training.
Databáze:	MEDLINE
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