Iranian Rehabilitation Journal
Volume:20 Issue: 50, Mar 2022

Upper limb motor impairment causes limited activities of daily living in stroke survivors. Bimanual therapy is based on Bimanual movement that facilitates cortical balancing by simultaneous movement of paretic and non-paretic arms while performing a task. Studies aimed at exploring the effects of resisted Bimanual therapy with rhythmic auditory cues on arm function, balance, and endurance in stroke survivors.

A pilot study was commenced after the institutional ethical committee approval. Twenty stroke survivors were randomly allocated into two treatment groups; Group A received conventional therapy along with resisted bimanual therapy with rhythmic auditory cues and group B received only conventional therapy. All patients received 14 treatment sessions within three weeks. Each session lasted for 45-60 minutes. The outcome measures used to assess hand function, trunk function, balance, gait, and endurance were Wolf Motor Function (WMFT), Trunk Impact Scale (TIS), Berg’s Balance Scale (BBS), Dynamic Gait Index (DGI), and Six Minute Walk Test (6MWT), respectively.

Pre-post-analysis in resisted bimanual therapy with rhythmic auditory cues showed statistically significant difference in WMFT (P=0.005), TIS (P=0.005), BBS (P=0.005), DGI (P=0.008), and 6MWT (P=0.003). Pre-post-analysis in conventional therapy showed statistically significant difference in WMFT (P=0.005), TIS (P=0.016), and BBS (P=0.014). Inter-group analysis of mean difference between resisted bimanual therapy with rhythmic auditory cues and conventional showed statistically significance difference in WMFT (P=0.037), TIS (P=0.003), BBS (P=0.0001), and DGI (P=0.004).

Although both groups showed improvement individually in arm function, balance, and functional capacity among stroke survivors, resisted bimanual therapy with rhythmic auditory cues showed better improvement than conventional therapy in all three components: arm function, balance, and functional capacity in stroke survivors.

This study aimed to investigate the effect of upper extremity coordination exercises based on fatigue prediction on fine and gross manual dexterity, upper limb motor function, shoulder and elbow proprioception, occupational performance, and activities of daily living in chronic stroke survivors.

In this pilot double-blind randomized clinical trial, 24 chronic strokes were enrolled using the non-probability sampling method. Participants were randomly allocated to the control (received routine occupational therapy) and intervention (received upper extremity coordination exercises based on fatigue prediction using the Kinect) groups. Before and after the interventions (six weeks, three sessions/week, 45 min/session), as well as six weeks after completion of interventions, participants were assessed using the following tools: Box-Block Test, Purdue-Pegboard Test, Wolf-Motor Function Test, Action Research Arm Test, Manual Ability Measure-16, Grip Dynamometer, Shoulder Position Sense Test (SPST), Elbow Position Sense Test (EPST), Canadian Occupational Performance Measure, Shah-Barthel Index (SH-BI), and Multi-dimensional Fatigue Inventory. This project was carried out in the rehabilitation department of Shafa-Yahyaeian Hospital from May 2019 to June 2020.

The results showed a significant improvement in all assessments of both control and intervention groups (P≤0.05), except for SH-BI. Further, the improvement of EPST and SPST scores in the intervention group was significantly greater than the control group (P≤0.05). Also, a significant decrease in fatigue severity was observed in both control and intervention groups (P≤0.05). 

These results suggest that upper extremity coordination exercises based on fatigue prediction in combination with routine occupational therapy could lead to improvement of upper extremity sensory-motor functions and power grip and caused a decrease in fatigue severity in chronic stroke.

This study was conducted to determine the prevalence and predictors of home fall among elderly people living in Qazvin City, Iran, 2018.

This cross-sectional study was performed on 300 elderly people aged 60 years or higher who were selected by cluster sampling technique. Data were collected by demographic and chronic diseases checklist, checklist of the characteristics of fall in the last year, Abbreviated Mental Test (AMT), self-reported health scale, and Timed Up and Go (TUG) test. The logistic regression model was conducted to determine predictors of home falls.

The mean age of the 300 older people who participated in the study was 70.11±8.90 years. Approximately, one-third of them (n=100, 33.3%) reported at least one fall during the last year. The results of the logistic regression revealed that the number of medicines used (OR=5.31, CI=1.44-19.49), history of the physical disease (OR=1.31, CI=1.01-1.70), age (OR=1.09, CI=1.03-1.15), balance control (OR=1.04, CI=0.07-1.01), and physical activity (OR=0.72, CI=0.57-0.92) were internal predictors of the fall among older adults.

The findings of our study disclosed that the incidence of falls is rather high among older people. The frequency of falls increased by advancing age, increase the number of physical illnesses and medicines used, poor balance, and a reduction in physical activity.

Fugl-Meyer Assessment (FMA) is the common scale for clinical and functional evaluation of sensorimotor conditions and related Upper Extremity (UE) dysfunction after stroke. This study was done to translate and cross-culturally adjust the original upper extremity FMA (FMA-UE) into Persian and to evaluate the psychometric properties of the translated version. 

A procedure of forward/backward translation based on the published guidelines was adopted and two independent bilingual translators performed the translations in each stage. The conceptual and semantic equivalence was obtained through a consensus between experts. Consecutive stroke patients (n=47, male=63%) with a mean age of 61.54±10.9 years were recruited. Content, face, and concurrent validity was calculated using the content validity index, a cognitive interview, and correlation with the Wolf Motor Function Test (WMFT). Internal consistency and intra-rater reliability were determined by calculating Cronbach’s alpha and the Intra-Class Correlation coefficient (ICC2.1).

During the forward translation and cultural adjustment, some wording changes were performed. In the forward translation, the most challenging clarifications are related to anatomical terms and positions. The total FMA-Persian score demonstrated acceptable internal consistency (α=0.86) and intra-rater reliability (ICC2.1=0.96). Joint passive motion showed the lowest reliability among all domains. The FMA motor subscales showed a floor effect, while sensation, joint passive motion, and pain domains showed ceiling effects. The correlation between the FMA-UE score and the WMFT was 0.78 (P<0.001). 

The FMA-UE translation and adjustment were performed successfully into the Persian language. The results of the current study found FMA-UE as an acceptable, reliable, and valid instrument for evaluating the upper limb function after stroke in Persian-speaking patients. However, it should be noted that floor and ceiling effects are respectively present in the domains of the motor subscales and for sensation, passive motion, and pain.

Physical exercise is a promising intervention to improve cognitive function and reduce the risk of dementia and other related neurodegenerative disorders. The present study aimed to investigate the effectiveness of an upper limb-focused physical exercise intervention on cognitive function and daily living activities in older adults. 

Forty older residents of a nursing home participated in this clinical trial and were randomly assigned to the experimental (n=20) or the control (n=20) groups. Participants in the experimental group received a physical exercise intervention for six weeks. This intervention included resistance training of the upper limbs using free weights. Evaluations were performed at baseline and after three and six weeks of the resistance training. Stroop test and Barthel index were used to evaluate cognitive function and daily living activities, respectively.

Upper limb resistance training significantly improved cognitive function in the experimental group, but there was no significant difference between the groups in the ability to perform daily activities.

The present study revealed that resistance training of the upper limb can yield cognitive improvement in older adults. Upper limb strengthening seems to have the potential to improve cognitive performance in the elderly and can be recommended as a regular exercise activity. However, further studies with more comprehensive outcome measures are needed.

Chronic musculoskeletal pain is a common problem in the elderly. Yoga exercise can be considered a non-pharmacological and complementary method for pain control. The present study was conducted to investigate the effect of yoga on chronic musculoskeletal pain in elderly females referring to selected health centers in Rafsanjan, Iran.

In this clinical trial, 60 females over 60 years of age with musculoskeletal pain were randomly divided into two intervention and control groups. The intervention group received three one-hour training sessions weekly for eight weeks, and they did yoga for 1 hour in each session. The pain was measured in both groups before the intervention and at weeks four and eight using the McGill Pain Questionnaire. The control group did not receive any special intervention.

The mean musculoskeletal pain decreased at the end of the 4th and 8th weeks after performing yoga in the intervention group compared to the control group (P<0.005). The subscales of sensory dimension and severity of pain showed no decrease after four weeks compared to the control group (P>0.005). However, at the end of the eighth week, all the pain subscales decreased in the intervention group (P<0.005).

The obtained results revealed that practicing yoga continuously could reduce musculoskeletal pain in elderly females; thus, it is suggested that such yoga exercises be included in the treatment of musculoskeletal pain in this group.

One of the most important problems seen in patients after stroke is that they cannot develop normal muscle strength. In recent years, the use of Mirror Therapy (MT) in the recovery of this condition has been noticed in different studies. This study investigated the effect of MT on motor recovery in patients after stroke.

In this clinical trial, 93 patients were divided into three groups, including MT, non-reflective surface, and control groups. The tools used in this study included the patient’s profile questionnaire, Mini-Mental State Examination Test, and Brunnstrom Recovery Stages. After the routine physiotherapy program, the intervention groups underwent MT for 20 sessions. The analysis of data was performed by SPSS software v. 22.

There was a significant difference between the non-reflective surface and MT groups (P=0.043) in pairwise comparison of their motor recovery stages in the 20th session, but the difference between the non-reflective surface and control groups was not significant. There was also a significant statistical difference between the MT and control groups in motor recovery stages in the 20th session, (P=0.0332) 

The obtained findings suggest that MT can increase patients’ motor recovery after stroke. This method can be used as a simple, cheap, and usable method at home.

In order to rehabilitate cognitive disorders, it is necessary to carefully evaluate cognitive function. Given the variety of assessments, including computerized and functional tests, the aim of this study was to determine whether computerized test scores really reflect a person’s functional ability. In this study, we measured the correlation between computerized and functional evaluation results.

In this cross-section study, 45 people (9 males and 36 females) with multiple sclerosis with an Expanded Disability Score (EDSS) of 1 to 5 were recruited. To assess their cognitive function, the CANTAB tests (SOC, DMS, and SSP tests) and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery were used. The data were then processed with SPSS software v. 22.

The results showed that the CANTAB test is well correlated with the LOTCA battery. A high correlation was observed between LOTCA’s “visual perception” with delayed matching to sample (r=0.909), LOTCA’s “spatial perception” with spatial span test (r=0.907), LOTCA’s “visual organization” with stocking of Cambridge (r=0.961), and “mental operations” in LOTCA with “stocking of Cambridge” (r=0.835). 

Due to the very good convergence of these two tests, in many cases, computerized tests can be used instead of functional tests.