The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke Paretic Upper-Limb Strength Best Explains Arm Activity in People With Stroke A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial. [The effect of neurorehabilitation on the functional state and muscle tone of upper limb in patients after ischaemic stroke]. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. Mobility training after hip fracture: a randomised controlled trial. Robotic-assisted rehabilitation of the upper limb after acute stroke. Randomized Trial of a Robotic Assistive Device for the Upper Extremity During Early Inpatient Stroke Rehabilitation Walking tolerance of patients recovering from hip fracture: a phase I trial Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction Upper limb motor rehabilitation impacts white matter microstructure in multiple sclerosis Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation. Stochastic Resonance Stimulation for Upper Limb Rehabilitation Poststroke Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study Robot training enhanced motor outcome in patients with stroke maintained over 3 years Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Virtual reality in the rehabilitation of the arm after hemiplegic stroke: a randomized controlled pilot study Effects of prolonged immobilization of the limb on radial artery mechanical properties. Television, computer, and video viewing; physical activity; and upper limb fracture risk in children: a population-based case control study. [Effects of the improved acupoints and rehabilitation exercise on locomotor ability of the upper limbs and ability of daily life in the patient of cerebral infarction]. Effects of exercise training on limb blood flow in patients with reduced ventricular function. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial
Background Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation . Initial severity of motor impairment , however , is not modifiable by rehabilitation , and increased one-on-one treatment is not always feasible . Alternative methods to increase intensity and improve upper-limb function are needed . Objective The purpose of this study was to examine  caregiver involvement in upper-limb treatment as a method to improve upper-limb function . Design This study was a secondary analysis of a multi-site r and omized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation . Methods Data from 50 individuals with subacute stroke who were r and omly assigned to the experimental group ( upper-limb exercise )  were used for the analysis . Outcome variables were measured at baseline and at completion of the 4-week intervention . Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance . Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment ( intensity ) as covariates , a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function , as measured by change scores on the Chedoke Arm and H and Activity Inventory and the Motor Activity Log . Results Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise . The multiple regression analysis showed that Fugl-Meyer score , treatment intensity , and caregiver support were significant predictors of upper-limb improvement ( R2=.240–.292 ) . In the regression models , caregiver support accounted for 5 % to 9 % of upper-limb improvement . Limitations Support was coded as a dichotomous variable , and thus the degree of support or qualitative nature of support was not captured . Conclusions Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity . Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results Background and Purpose The purpose of this study was to determine the relationship among variables of upper-limb impairment , upper-limb performance in activities of daily living ( activity ) , and engagement in life events and roles ( participation ) in people with chronic stroke . Subjects The subjects were 93 community-dwelling individuals with stroke ( ≥1 year ) . Methods This study , which was conducted in a tertiary rehabilitation center , used a cross-sectional design . The main measures of impairment were the Modified Ashworth Scale , h and held dynamometry , sensory testing ( monofilaments ) , and the Brief Pain Inventory .  The main measures of activity were the  Chedoke Arm and H and Activity Inventory ( CAHAI ) and the Motor Activity Log ( MAL ) . The main measure of participation was the Reintegration to Normal Living ( RNL ) Index . Results Paretic upper-limb strength ( force-generating capacity ) ( r=.89 , P<.01 ) , grip strength ( r=.69 , P<.01 ) , and tone ( resistance to passive movement ) ( r=−.80 , P<.01 ) were the impairment variables that were most strongly related to activity . Tone ( r=−.23 , P<.05 ) and CAHAI scores ( r=.22 , P<.05 ) had a significant , but weak , relationship to participation . Upper-limb strength accounted for 87 % of the variance of the CAHAI scores and 78 % of the variance of the MAL scores . In the participation models , tone and CAHAI scores accounted for 5 % of the variance of the RNL Index scores . Discussion and Conclusion Paretic upper-limb strength had the strongest relationship with variables of activity and best explained upper-limb performance in activities of daily living . Grip strength , tone , and sensation also were factors of upper-limb performance in activities of daily living . Increased tone and upper-limb performance in activities of daily living had a weak relationship with participation QUESTION Does a program of exercise and structured advice implemented during the rehabilitation phase following a distal radial fracture achieve better recovery of upper limb activity than structured advice alone ? DESIGN A phase I/II , multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding and intention-to-treat analysis . PARTICIPANTS Thirty-three adults ( 25 female , mean age 54 years ) following distal radial fracture managed in a cast . INTERVENTION The experimental intervention was a 6-week program of progressive exercise and structured advice implemented over three consultations by a physiotherapist . The control intervention was a program of structured advice only , delivered by a physiotherapist over three consultations . OUTCOME MEASURES The primary outcome was upper limb activity limitations , assessed by the Patient-Rated Wrist Evaluation and the shortened version of the Disabilities of the Arm , Shoulder and H and outcome measure ( QuickDASH ) . The secondary outcomes were wrist range of movement , grip strength and pain . All measures were completed at baseline ( week 0 ) , after the intervention ( week 7 ) and at 6 months ( week 24 ) . RESULTS There were no significant between-group differences in upper limb activity as measured by the Patient-Rated Wrist Evaluation at week 7 and week 24 assessment s ( mean difference -4 units , 95 % CI -10 to 2 ; mean difference 0 units , 95 % CI -3 to 3 , respectively ) , or QuickDASH at week 7 and week 24 assessment s ( mean difference -5 units , 95 % CI -16 to 6 ; mean difference 0.3 units , 95 % CI -6 to 7 , respectively ) . The secondary outcomes did not demonstrate any significant between-group effects . CONCLUSION The prescription of exercise in addition to a structured advice program over three physiotherapy consultations may convey no extra benefit following distal radial fracture managed in a cast . TRIAL REGISTRATION ACTRN12612000118808 . [ Bruder AM , Shields N , Dodd KJ , Hau R , Taylor NF ( 2016 ) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture : a multi-centre , r and omised trial . Journal of Physiotherapy62 : 145 - 152 ] UNLABELLED Rehabilitation of upper limb in patients after ischemic stroke is a major challenge for modern neurorehabilitation . Function of upper limb of patients after ischemic stroke returns on the end of the rehabilitation comparing with another parts of the body . Below presents two groups of patients after ischemic stroke who were rehabilitated with use of the following methods : kinesiotherapy combined with NDT- Bobath method and kinesiotherapy only . The aim of this study was to assess the impact of kinesiotherapy only and NDT- Bobath method combined with kinesiotherapy on the functional state and muscle tone of upper limb in patients after ischemic stroke . MATERIAL AND METHODS The study involved a group of 40 patients after ischemic stroke with motor control and muscle tone problems of upper limb . Patients were divided into two groups , each of them included 20 people . Upper limb in group I was rehabilitated with the use of kinesiotherapy exercise however group II with the use of kinesiotherapy exercise combined with NDT- Bobath method ( Neurodevelopmental Treatment Bobath ) . To evaluate the patients before and after rehabilitation muscle tone Asworth scale was used and to assess functional status Rivermead Motor Assessment ( RMAIII ) scale was used . RESULTS After 5 weeks of rehabilitation in group II in majority patients were observed decrease of muscle tone and improvement in upper limb functional status . In group I the muscle tone were also decreased and functional status were better but in smaller impact than in II group . CONCLUSIONS Classical kinesiotherapy combined with the NDT-Bobath method gives better results in neurorehabilitation of upper limb than the use of kinesiotherapy exercises only in patients after ischemic stroke The capacity for physiotherapy to improve the outcome after fracture of the distal radius is unproven . We carried out a r and omised controlled trial on 96 patients , comparing conventional physiotherapy with a regime of home exercises .  The function of the upper limb was assessed at the time of removal of the plaster cast and at three and six months after injury . Factors which may predict poor outcome in these patients were sought . Grip strength and h and function did not significantly differ between the two groups . Flexion and extension of the wrist were the only movements to improve with physiotherapy at six months ( p = 0.001 ) . Predictors of poor functional outcome were malunion and impaired function before the fracture . These patients presented with pain , decreased rotation of the forearm and low functional scores at six weeks . Our study has shown that home exercises are adequate rehabilitation after uncomplicated fracture of the distal radius , and routine referral for a course of physiotherapy should be discouraged . The role of physiotherapy in patients at high risk of a poor outcome requires further investigation OBJECTIVE to compare the effects of two different exercise programmes after hip fracture . DESIGN assessor-blinded r and omised controlled trial . SETTING hospital rehabilitation units , with continued intervention at home . SUBJECTS 160 people with surgical fixation for hip fracture transferred to inpatient rehabilitation . METHOD in addition to other rehabilitation strategies , the intervention group received a higher dose ( 60 min/day ) exercise programme conducted whilst st and ing and the control group received a lower dose exercise programme ( 30 min/day ) primarily conducted whilst seated/supine . The primary outcome measures were knee extensor muscle strength in the fractured leg and walking speed , measured at 4 and 16 weeks . RESULTS 150 participants ( 94 % of those recruited ) completed the trial . There were no differences between the groups for the two primary outcome measures . Post hoc analyses revealed increased walking speed among those in the higher dose , weight-bearing exercise group with cognitive impairment at 4 and 16 weeks . CONCLUSIONS there was no benefit ( or harm ) due to the higher dose , weight-bearing exercise programme with respect to the primary outcome measures . However , people with hip fracture and cognitive impairment gained greater benefit from the higher dose programme than from the lower dose programme OBJECTIVE To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb . DESIGN A single-blind r and omized controlled trial , with an 8-month follow-up . SETTING Neurologic department and rehabilitation hospital . PARTICIPANTS Thirty-five patients with acute ( < or = 1 wk of onset ) , unilateral , ischemic embolic , or thrombotic stroke . INTERVENTIONS Patients of both groups received the same dose and length per day of st and ard poststroke multidisciplinary rehabilitation . Patients were r and omly assigned to 2 groups . The experimental group ( n=17 ) received additional early sensorimotor robotic training , 4 hours a week for 5 weeks ; the control group ( n=18 ) was exposed to the robotic device , 30 minutes a week , twice a week , but the exercises were performed with the unimpaired upper limb . Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb , correlated with visual stimuli . MAIN OUTCOME MEASURES The Fugl-Meyer Assessment ( FMA ) of upper-extremity function ( shoulder/elbow and coordination and wrist/h and subsections ) to measure each trained limb segment ; the Medical Research Council ( MRC ) score to measure the strength of muscle force during 3 actions : shoulder abduction ( MRC deltoid ) , elbow flexion ( MRC biceps ) , and wrist flexion ( MRC wrist flexors ) ; the FIM instrument and its motor component ; and the Trunk Control Test ( TCT ) and Modified Ashworth Scale ( MAS ) . RESULTS Compared with the patients in the control group , the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy , as measured by the MRC deltoid ( P < or = .05 ) and biceps ( P<.05 ) scores , the FMA for the proximal upper arm ( P<.05 ) , the FIM instrument ( P<.05 ) , and the FIM motor score ( P<.01 ) ; these gains were also sustained at the 3- and 8-month follow-up . The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions . We found no significant differences in MAS and TCT in either group in any of the evaluations . No adverse effects occurred and the robotic approach was very well accepted . CONCLUSIONS Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities . Robotic therapy may therefore effectively complement st and ard rehabilitation from the start , by providing therapeutic support for patients with poststroke plegic and paretic upper limb Background . A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy . Objective . We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of st and ard upper limb rehabilitation in post – acute stroke patients . Methods . In this dose-matched , r and omized controlled clinical trial , 34 hemiparetic participants with movement against gravity in shoulder , elbow , and wrist muscle groups were enrolled within 15 days of the onset of stroke . All participants received a total daily rehabilitation treatment for 120 minutes , 5 days per week for 5 weeks . The control group received st and ard therapy for the upper limb . The experimental group received st and ard therapy ( 65 % of exercise time ) associated with robotic training ( 35 % of exercise time ) . Muscle tone ( Modified Ashworth Scale ) , strength ( Medical Research Council ) , and synergism ( Fugl-Meyer motor scores ) were measured at impairment level , whereas dexterity ( Box and Block Test and Frenchay Arm Test ) and activities of daily living ( Functional Independence Measure ) were measured at activity level . All assessment s were performed at baseline , at the end of therapy ( time T1 ) , at 3 months ( time T2 ) , and at 7 months ( time T3 ) after entry . All between-group analyses were tested using nonparametric test with Bonferroni ’s adjustments for multiple testing . Results . No significant between-group differences were found with respect to demographic characteristics , motor , dexterity , and ADLs at baseline , postintervention ( T1 ) and at follow-up ( T2 and T3 ) . Conclusions . The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation Abstract Purpose : To find out how much physical activity in the form of walking can be tolerated by adults admitted for inpatient rehabilitation after hip fracture . Method : Using a phase I dose – response design , in addition to usual scheduled rehabilitation care  participants without cognitive impairment were supervised to walk for a prescribed length of time on 5 consecutive days . Doses started at 3 min and were escalated when three participants successfully completed a dose . Secondary outcomes included physical activity and the Ambulatory Self-Confidence Question naire ( ASCQ ) . Results : The maximum tolerated dose of  walking  for the 13 participants ( 4 men and 9 women ; mean age 81 years , SD 10 ) was 6 min . At 10 min only 1 of 5 participants was able to complete the dose . The main reason for not tolerating the prescribed dose was fatigue . Participants had relatively low levels of daily physical activity ( mean 507 steps/day ) , and lacked confidence in their walking ( ASCQ mean 4.6 ) . Conclusion : Physical activity guidelines for older people are not appropriate for patients in active inpatient rehabilitation recovering from hip fracture where other factors such as fatigue may limit physical activity levels . These results can be taken into account when design ing rehabilitation programmes after hip fracture . Implication s for Rehabilitation Hip fracture is a common and serious fracture with ongoing disability for which people require inpatient rehabilitation to prepare for return to independent living in the community . The maximum tolerated dose of walking of 6 minutes suggests physical activity guidelines for older people are not applicable for those receiving active inpatient rehabilitation after hip fracture . The maximum tolerated dose of walking of 6 minutes during inpatient rehabilitation suggests rehabilitation programmes be structured to allow adequate time for recovery Purpose : This study examined the role of anxiety and upper limb dysfunction , amongst other variables , as predictors of health related quality of life ( HRQOL ) 6 months after stroke . Method : Participants : Stroke survivors ( n = 85 ) who had previously participated in a r and omised controlled trial of a physiotherapy intervention .  Dependent variable : HRQOL – Nottingham Health Profile ( NHP ) . Predictor variables : Mood – Hospital Depression and Anxiety Scale ; Upper Limb Functioning - Action Research Arm Test ; Rivermead Motor Assessment ; Activities of Daily Living – Modified Barthel Index ; Clinical and demographic factors . Results : Anxiety and depression significantly predicted 49 % of variance in overall HRQOL ( p < 0.05 ) , but only anxiety significantly predicted NHP pain ( 13 % variance , p < 0.001 ) , emotional reactions ( 41 % variance , p < 0.001 ) , sleep ( 19 % variance , p = 0.02 ) and social isolation ( 23 % variance , p = 0.02 ) . Depression and anxiety together significantly predicted 30 % variance in energy level ( p < 0.001 ) . UL motor impairment and activities of daily living predicted 36 % of variance in NHP physical activity score ( p < 0.001 ) . Conclusions : This study indicates that where anxiety is assessed , it appears more important in determining HRQOL than depression . UL impairment and ADL independence predicted perceived physical activity . Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL . Implication s for Rehabilitation Anxiety is a major predictor of quality of life six months after stroke . Post-stroke anxiety should be routinely assessed in rehabilitation . Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period . Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke . Rehabilitation of the upper limb should continue into the chronic post-stroke period Upper limb impairments can occur in patients with multiple sclerosis , affecting daily living activities ; however there is at present no definite agreement on the best rehabilitation treatment strategy to pursue . Moreover , motor training has been shown to induce changes in white matter architecture in healthy subjects . This study aim ed at evaluating the motor behavioral and white matter microstructural changes following a 2-month upper limb motor rehabilitation treatment based on task-oriented exercises in patients with multiple sclerosis . Thirty patients ( 18 females and 12 males ; age=43.3 ± 8.7 years ) in a stable phase of the disease presenting with mild or moderate upper limb sensorimotor deficits were r and omized into two groups of 15 patients each . Both groups underwent twenty 1-hour treatment sessions , three times a week . The " treatment group " received an active motor rehabilitation treatment , based on voluntary exercises including task-oriented exercises , while the " control group " underwent passive mobilization of the shoulder , elbow , wrist and fingers . Before and after the rehabilitation protocol s , motor performance was evaluated in all patients with st and ard tests . Additionally , finger motor performance accuracy was assessed by an engineered glove . In the same sessions , every patient underwent diffusion tensor imaging to obtain parametric maps of fractional anisotropy , mean diffusivity , axial diffusivity , and radial diffusivity . The mean value of each parameter was separately calculated within regions of interest including the fiber bundles connecting brain areas involved in voluntary movement control : the corpus callosum , the corticospinal tracts and the superior longitudinal fasciculi . The two rehabilitation protocol s induced similar effects on unimanual motor performance , but the bimanual coordination task revealed that the residual coordination abilities were maintained in the treated patients while they significantly worsened in the control group ( p=0.002 ) . Further , in the treatment group white matter integrity in the corpus callosum and corticospinal tracts was preserved while a microstructural integrity worsening was found in the control group ( fractional anisotropy of the corpus callosum and corticospinal tracts : p=0.033 and p=0.022 ; radial diffusivity of the corpus callosum and corticospinal tracts : p=0.004 and p=0.008 ) . Conversely , a significant increase of radial diffusivity was observed in the superior longitudinal fasciculi in both groups ( p=0.02 ) , indicating lack of treatment effects on this structure , showing damage progression likely due to a demyelination process . All these findings indicate the importance of administering , when possible , a rehabilitation treatment consisting of voluntary movements . We also demonstrated that the beneficial effects of a rehabilitation treatment are task-dependent and selective in their target ; this becomes crucial towards the implementation of tailored rehabilitative approaches OBJECTIVE To describe the impairments of upper body and limbs , activity limitations and participation restrictions 6 and 12 months after operation for breast cancer and to examine the impact of impairments on activity limitations . DESIGN A prospect i ve survey 6 and 12 months after operation . PATIENTS Ninety-six breast cancer patients . METHODS A question naire for assessing the impairments , activity limitations and participation restrictions was developed . RESULTS The most common impairments 6 months after operation were breast and axilla scar tightness , axilla oedema and neck-shoulder pain . At 12-month follow-up the breast scar tightness ( p=0.008 ) and axilla oedema ( p=0.023 ) decreased , and limb ache ( p=0.005 ) increased significantly . The most limiting impairments were axilla oedema and limb numbness 6 months after operation , and at 12-month follow-up axilla oedema . Lifting , carrying and reaching out caused worsening of impairments to more than half of the respondents at 6-month follow-up . Regression analysis showed that many impairments together were determinants of activity limitations and sleep impairment . Participation restrictions were constant . Respondents had not given up participation in activities in the home , but some had ab and oned leisure activities and felt that their work ability had decreased . CONCLUSION Impairments and their impact on activities were frequent and constant . There is an urgent need for developing rehabilitation protocol s for breast cancer patients Stein J , Hughes R , D ' And rea S , Therrien B , Niemi J , Krebs K , Langone L , Harry J : Stochastic resonance stimulation for upper limb rehabilitation poststroke . Objectives : Previous studies have shown that subthreshold electrical or mechanical noise can reduce the sensory threshold and impart short-term improvements in sensorimotor function . We undertook this study to examine the effects of combined subsensory electrical and vibratory stimulation in conjunction with exercise training on long-term motor performance . Design : Thirty subjects were recruited from adult community-dwelling stroke survivors with residual hemiparesis . Subjects were screened for residual motor ability using a functional task , and those who functioned below this level were excluded . All subjects had a history of a single unilateral ischemic or hemorrhagic stroke at least 6 mos before study entry and were not actively receiving occupational or physical therapy . Subjects were stratified by baseline upper extremity Fugl-Meyer ( UEFM ) ( more impaired [ 28–35 ] and less impaired [ 36–55 ] ) and were r and omized to one of two groups : treatment ( stochastic resonance stimulation [ plus over minus sign ] exercise : 15 subjects ) and control ( sham stimulation [ plus over minus sign ] exercise : 15 subjects ) . Results : No significant difference was found between the stochastic resonance treatment and control group in the UEFM or in any of the secondary measures . The combined group showed modest improvements in UEFM from baseline to completion of therapy ( mean improvement , 2.6 points ) ( P = 0.004 ) ; however , these improvements declined by 1-mo follow-up to 1.5 points ( P = 0.055 ) . No change in sensory function was detectable . Conclusions : Stochastic resonance therapy combined with occupational therapy was no more effective than occupational therapy alone in restoring sensorimotor performance . Other stochastic resonance stimulation montages or protocol s might prove more effective The use of activity-dependent interventions has shown some success in promoting recovery of upper limb function in chronic stroke patients . This study compared the neurophysiological and behavioural changes associated with two such rehabilitation protocol s : unilateral and bilateral movement training .  Twelve chronic stroke patients were r and omly assigned to the two training protocol s involving six daily practice sessions . Each session consisted of 50 trials of a dowel placement task performed either with both impaired and unimpaired arm moving synchronously ( bilateral training group ) or with only the impaired arm moving ( unilateral training ) . Kinematic measurements of upper limb movements were made in four unilateral test trials performed prior to and following each practice session . Functional assessment s of the impaired upper limb and neurophysiological assessment s , using transcranial magnetic stimulation ( TMS ) , of the affected and non-affected cortical hemispheres were made prior to and following the intervention sessions . Individuals receiving bilateral training showed a reduction in movement time of the impaired limb and increased upper limb functional ability compared to individuals receiving unilateral training . In some patients changes to upper limb function were associated with changes to the cortical representation of a target muscle in the non-affected hemisphere . Overall , these findings suggest that a short-term bilateral training intervention may be effective in facilitating upper limb motor function in chronic stroke patients Article abstract In an attempt to improve motor recovery of the upper limb after stroke , we added a robot ( MIT-Manus ) experience that provided additional goal -directed sensorimotor activity to st and ard rehabilitation treatments . The first trial produced a significant decrease in motor impairment in the upper limb for the treated group . In re-evaluating 12 of those 20 patients , nearly 3 years later , robot-trained patients showed further significant decreases in impairment measures of the affected limb . The groups were comparable at the start of the study Manual dexterity is a skill frequently evaluated in rehabilitation to estimate h and function . Several tests have been developed for this purpose , including the Box and Block Test ( BBT ) that measures gross manual dexterity . The goal of the present study was to verify the test-retest reliability and construct validity of the BBT with subjects aged 60 and over with upper limb impairment . The second objective of this research was to develop normative data based on a r and om sample of healthy elderly community-living individuals . The results show that the test-retest reliability is high ( intraclass correlations coefficients of 0.89 to 0.97 ) and the validity of the test is shown by significant correlations between the BBT , an upper limb performance measurement and a functional independence measurement . The norms will help rehabilitation clinicians to differentiate better between real difficulties and those that may be attributed to normal aging OBJECTIVE to evaluate the effects of brisk walking on bone mineral density in women who had suffered an upper limb fracture . DESIGN r and omized placebo-controlled trial . Assessment s of bone mineral density were made before and at 1 and 2 years after intervention . St and ardized and vali date d measures of physical capacity , self-rated health status and falls were used . SETTING district general hospital outpatient department . SUBJECTS 165 women drawn from local accident and emergency departments with a history of fracture of an upper limb in the previous 2 years . Women were r and omly allocated to intervention ( self-paced brisk walking ) or placebo ( upper limb exercises ) groups . INTERVENTION both groups were seen at 3-monthly intervals to assess progress , measure physical capacity and maintain enthusiasm . The brisk-walking group were instructed to progressively increase the amount and speed of walking in a manner that suited them . The upper limb exercise placebo group were asked to carry out a series of exercises design ed to improve flexibility and fine h and movements , appropriate for a past history of upper limb fracture . RESULTS drop-outs from both intervention and placebo groups were substantial ( 41 % ) , although there were no significant differences in bone mineral density , physical capacity or health status between drop-outs and participants . At 2 years , among those completing the trial , bone mineral density at the femoral neck had fallen in the placebo group to a greater extent than in the brisk-walking group [ mean net difference between intervention and placebo groups 0.019 g/cm2 , 95 % confidence interval ( CI ) -0.0026 to + 0.041 g/cm2 , P = 0.056 ] . Lumbar spine bone mineral density had increased to a similar extent ( + 0.017 g/cm2 ) in both groups . The cumulative risk of falls was higher in the brisk-walking group ( excess risk of 15 per 100 person-years , 95 % CI 1.4 - 29 per 100 person-years , P < 0.05 ) . There were no significant differences in clinical or spinal x-ray fracture risk or self-rated health status between intervention and placebo groups . CONCLUSION the promotion of exercise through brisk-walking advice given by nursing staff may have a small , but clinical ly important , impact on bone mineral density but is associated with an increased risk of falls . Self-paced brisk walking is difficult to evaluate in r and omized controlled trials because of drop-outs , placebo group exercise , limited compliance and lack of st and ardization of the duration and intensity of walking . Further work is needed to evaluate the best means of safely achieving increased activity levels in different groups , such as older women and those at high risk of fractures Objective : To assess the feasibility of a trial to investigate the effectiveness of virtual reality-mediated therapy compared to conventional physiotherapy in the motor rehabilitation of the arm following stroke , and to provide data for a power analysis to determine numbers for a future main trial . Design : Pilot r and omized controlled trial . Setting : Clinical research facility . Participants : Eighteen people with a first stroke , 10 males and 8 females , 7 right and 2 left side most affected . Mean time since stroke 10.8 months . Interventions : Participants were r and omized to a virtual reality group or a conventional arm therapy group for nine sessions over three weeks . Main measures : The upper limb Motricity Index and the Action Research Arm Test were completed at baseline , post intervention and six weeks follow-up . Results : Outcome data were obtained from 95 % of participants at the end of treatment and at follow-up : one participant withdrew . Compliance was high ; only two people reported side-effects from virtual reality exposure . Both groups demonstrated small ( 7–8 points on upper limb Motricity Index and 4 points on the Action Research Arm Test ) , but non-significant , changes to their arm impairment and activity levels . Conclusion : A r and omized controlled trial of virtual reality-mediated therapy comparable to conventional therapy would be feasible , with some suggested improvements in recruitment and outcome measures . Seventy-eight participants ( 39 per group ) would be required for a main trial Physical training is associated with an increase in arterial distensibility . Whether the effect of training on this variable is evident also for ordinary levels of exercise or no exercise is unknown , however . We have addressed this issue by investigating the effect on radial artery distensibility of prolonged monolateral immobilization of the ipsilateral limb versus the following resumption of normal mobility . We studied 7 normotensive subjects ( age , 25.4+/-3.0 years ; systolic/diastolic blood pressure , 119+/-9/68+/-6 mm Hg , mean+/-SE ) in whom 1 limb had been immobilized for 30 days in plaster because of a fracture of the elbow . At both the day after plaster removal and after 45 days of rehabilitation , radial artery distensibility was evaluated by an  echo-tracking device ( NIUS-02 ) , which allows arterial diameter to be measured noninvasively and continuously over all pressures from diastole to systole ( finger monitoring ) , with the distensibility values being continuously derived from the Langewouters formula . In both instances , the contralateral arm was used as control . Immediately after removal of the plaster , radial artery distensibility was markedly less in the previously immobilized and fractured limb compared with the contralateral limb ( 0.4+/-0.1 versus 0.8+/-0.1 , 1/mm Hg 10(-3 ) , P<0.05 ) . After rehabilitation , the distensibility of the radial artery was markedly increased in the previously fractured limb ( 0.65+/-0.1 1/mm Hg 10(-3 ) , P<0.05 ) , whereas no change was seen in the contralateral limb . Thus , complete interruption of physical activity is associated with a marked reduction of arterial distensibility , indicating that even an ordinary level of activity plays a major role in modulation of arterial mechanical properties UNLABELLED The effect of physical activity on upper limb fractures was examined in this population -based case control study with 321 age- and gender-matched pairs .  Sports participation increased fracture risk in boys and decreased risk in girls . Television viewing had a deleterious dose response association with wrist and forearm fractures while light physical activity was protective . INTRODUCTION The aim of this population -based case control study was to examine the association between television , computer , and video viewing ; types and levels of physical activity ; and upper limb fractures in children 9 - 16 years of age . MATERIAL S AND METHODS A total of 321 fracture cases and 321 r and omly selected individually matched controls were studied .  Television , computer , and video viewing and types and levels of physical activity were determined by interview-administered question naire . Bone strength was assessed by DXA and metacarpal morphometry . RESULTS In general , sports participation increased total upper limb fracture risk in boys and decreased risk in girls . Gender-specific risk estimates were significantly different for total , contact , noncontact , and high-risk sports participation as well as four individual sports ( soccer , cricket , surfing , and swimming ) . In multivariate analysis , time spent television , computer , and video viewing in both sexes was positively associated with wrist and forearm fracture risk ( OR 1.6/category , 95 % CI : 1.1 - 2.2 ) , whereas days involved in light physical activity participation decreased fracture risk ( OR 0.8/category , 95 % CI : 0.7 - 1.0 ) . Sports participation increased h and ( OR 1.5/sport , 95 % CI : 1.1 - 2.0 ) and upper arm ( OR 29.8/sport , 95 % CI : 1.7 - 535 ) fracture risk in boys only and decreased wrist and forearm fracture risk in girls only ( OR 0.5/sport , 95 % CI : 0.3 - 0.9 ) . Adjustment for bone density and metacarpal morphometry did not alter these associations . CONCLUSION There is gender discordance with regard to sports participation and fracture risk in children , which may reflect different approaches to sport . Importantly , television , computer , and video viewing has a dose-dependent association with wrist and forearm fractures , whereas light physical activity is protective . The mechanism is unclear but may involve bone-independent factors , or less likely , changes in bone quality not detected by DXA or metacarpal morphometry OBJECTIVE To search for an effective method for improving locomotor ability of upper limbs and ability of daily life in the patient of cerebral infa rct ion . METHODS Five hundred and seventy-eight cases of stroke were r and omly divided into 4 groups : an improved acupoints and rehabilitation exercise group ( group A , n = 148 ) , a rehabilitation exercise group ( group B , n = 142 ) , a routine acupoints and rehabilitation exercise group ( group C , n = 144 ) , and a medication group ( group D , n = 144 ) . The locomotor ability of the upper limbs and ability of daily life were evaluated respectively by Fugl-Meyer ( FMA ) and Barthel ( BMI ) . RESULTS There were significant differences in FMA and BMI scores in all the groups after treatment as compared with those before treatment ( P < 0.05 ) ; after treatment , the effect in the group A was significantly superior to those in group B and C ( P < 0.05 ) , with no significant difference between the group C and the group B. CONCLUSION The improved acupoints combined with rehabilitation exercise can improve locomotor ability of the upper limbs and ability of daily life in the patient of cerebral infa rct ion BACKGROUND Among the factors that contribute to limiting exercise tolerance in chronic heart failure are reduced peripheral blood flow and impaired vasodilatory capacity . Exercise training improves vasodilatory capacity in normal subjects , but controlled studies of exercise training evaluating upper and lower limb blood flow rates have not been performed in patients with reduced ventricular function . Improved vasodilatory capacity could help explain how training increases exercise capacity in these patients . METHODS Twenty patients ( mean age 55 + /- 6 years ) with reduced left ventricular function ( mean ejection fraction 32 % + /- 6 % ) after a myocardial infa rct ion were r and omized to a 2-month  high-intensity residential rehabilitation program or to a control group and were monitored over the subsequent year . Both groups were treated according to current practice with angiotensin-converting enzyme inhibition therapy . Training began 1 month after myocardial infa rct ion . Baseline and postischemic flow rates were measured by plethysmography in both the upper and lower limbs 1 month , 3 months , and 1 year after the infa rct ion . Peak oxygen uptake ( VO2 ) and cardiac output were measured before and after training , and peak VO2 was determined again after 1 year . RESULTS After 2 months of training  peak VO2 increased 25 % , VO2 at the lactate threshold increased 40 % , and maximal cardiac output increased from 12.1 + /- 1.6 L/min to 13.9 + /- 2.4 L/min in the exercise group ( all p < 0.05 ) , whereas no differences were observed in the control group . At the 1-year follow-up no further increases in peak VO2 were noted in either group , but the higher value persisted in the trained group . However , changes in limb flow rates were poorly related to changes in both peak VO2 and maximal cardiac output . Improvements in baseline and postischemic flow rates occurred mainly in the lower limbs and were observed in the two groups to a similar degree . CONCLUSION Exercise training is highly effective in improving exercise capacity in patients with reduced ventricular function after myocardial infa rct ion . These improvements parallel an increase in maximal cardiac output , but they are unrelated to vasodilatory capacity . In patients with reduced ventricular function after myocardial infa rct ion , lower limb vasodilatory capacity improves gradually over the subsequent year , and these improvements occur irrespective of exercise training Background Recent evidence has demonstrated the efficacy of Virtual Reality ( VR ) for stroke rehabilitation nonetheless its benefits and limitations in large population of patients have not yet been studied . Objectives To evaluate the effectiveness of non-immersive VR treatment for the restoration of the upper limb motor function and its impact on the activities of daily living capacities in post-stroke patients . Methods A pragmatic clinical trial was conducted among post-stroke patients admitted to our rehabilitation hospital . We enrolled 376 subjects who had a motor arm subscore on the Italian version of the National Institutes of Health Stroke Scale ( It-NIHSS ) between 1 and 3 and without severe neuropsychological impairments interfering with recovery . Patients were allocated to two treatments groups , receiving combined VR and upper limb conventional ( ULC ) therapy or ULC therapy alone . The treatment programs consisted of 2 hours of daily therapy , delivered 5 days per week , for 4 weeks . The outcome measures were the Fugl-Meyer Upper Extremity ( F-M UE ) and Functional Independence Measure ( FIM ) scales . Results Both treatments significantly improved F-M UE and FIM scores , but the improvement obtained with VR rehabilitation was significantly greater than that achieved with ULC therapy alone . The estimated effect size of the minimal difference between groups in F-M UE and FIM scores was 2.5 ± 0.5 ( P < 0.001 ) pts and 3.2 ± 1.2 ( P = 0.007 ) pts , respectively . Conclusions VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities . Trial registration Italian Ministry of Health IRCCS Research Programme
There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures
QUESTION What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures ?