the effectiveness of telerehabilitation in stroke patients

Conditions: Stroke

Summary: stroke, according to the definition of the world health organization (who); it is a syndrome characterized by a rapid settlement of signs and symptoms of focal loss of cerebral function without a cause other than vascular causes. as it is known, it is important for patients to regain functional skills in the upper extremities after stroke. modified-constraint induced movement therapy (m-cimt) is a versatile neurorehabilitation technique that aims to improve motor function in the hemiparetic upper extremity and increase its use in daily life activities. however, as in the covid-19 pandemic, patients cannot always reach rehabilitation services. in such cases, telerehabilitation is a treatment option. there are a limited number of studies in which m-cimt is applied according to the principle of telerehabilitation, which has become a necessity, especially due to the covid-19 pandemic. therefore, the aim of this study is to examine the effects of m-cimt on upper extremity motor functions in stroke patients.

this study is a randomized controlled study. the patients will be randomly divided into two groups as exercise and control. patients in both groups will be given lower-upper extremity exercises and gait training exercises selected according to the bobath approach as a home program consisting of 10 exercises to be applied 5 days a week for 3 weeks. all patients will perform the same exercises. in addition, the exercise group will receive modified-constraint induced movement therapy (m-cimt) based telerehabilitation via video conferencing 5 days a week for 3 weeks. patients in the m-cimt group will be asked to restrict the movements of their less affected hands by using mitt for 5 hours a day/ 5 days a week for 3 weeks while the patients are awake. evaluations for both groups will be made by a physiotherapist blinded to the study twice, at the beginning and 3 weeks later. as outcome measures functional performance, hand strength, activities of daily living and quality of life will be evaluated.

Eligibility criteria:
inclusion criteria: * 18-65 years of age * being diagnosed with stroke for the first time by a doctor * having been diagnosed with stroke at least 1 month ago * mini-mental test score more than or equal 24 * in the upper extremities; starting from the angle of full flexion, wrist extension of at least 20° or more, thumb extension or abduction of at least 10°, minimum extension of all other fingers at the metacarpophalangeal and interphalangeal joints * having less than 2.5 points in the pre-treatment evaluation from both parts of mag-28 * being able to stand for 2 minutes without any help by using the upper extremity as a support tool when necessary. * absence of severe pain to affect the treatment * absence of severe spasticity to affect the treatment (spasticity in any joint of the upper extremity ≤ 2 according to the modified ashworth scale) exclusion criteria: * any orthopedic, vision, hearing or perception problems that may affect the research results * having an additional neurological, cardiovascular, pulmonary or hormonal disorder that would prevent participation in the study.

Keywords: stroke telerehabilitation modified-constraint induced movement therapy upper extremity